Combined transepicardial and transseptal implantation of autologous CD 133+ bone marrow cells during bypass grafting improves cardiac function in patients with low ejection fraction

Abstract

Objectives Autologous CD133+ bone marrow stem cells may improve cardiac function. This randomized, single‐blind clinical trial inquired whether a combined transepicardial and transseptal implantation of CD133+ stem cells during coronary artery bypass grafting (CABG) improve cardiac function with ejection fraction (EF) changes as a primary endpoint in patients with low EF. Methods Thirty patients with coronary heart disease and EF <35% were randomized to undergo CABG alone or CABG with transseptal and transepicardial implantation of CD133+. Cardiac function was evaluated using cardiac magnetic resonance imaging (MRI) before and 6 months after CABG. Results Preoperative EF was lower in the intervention group (25.88% ± 5.66%) than in the control group (30.18% ± 3.85%; P = .04). The adverse event incidence was similar between both groups. At 6 months, EF changes were significantly higher (8.69% ± 9.49; P = .04) in the CD133+ group than in the CABG‐only group. Compared to the control group, significant improvements were seen in the wall motion score index (P = .003) and scar size proportion (P = .047) in the CD133+ group. The quality of life (QOL), assessed by a 6‐minute walking test, showed considerable improvement in the CD133+ group compared to that in the control group (P = .03). The Minnesota Living with Heart Failure Questionnaire (MLHFQ) scale did not show improvement in the intervention group (P = .09, vs control). Conclusion Combined transepicardial and transseptal autologous CD133+ BMC implantation during bypass grafting improved cardiac function in low EF coronary artery disease patients.

Human stem cells – sources, sourcing and in vitro methods

“…Improvement was also noticed in scar size proportion in CD133+ group. These results suggest that this treatment may be applied for better cardiac repair and patient's better life quality [111].…”

Effectiveness of Stem Cell Therapies in Improving Clinical Outcomes in Patients With Heart Failure

“…Soestina et al published the results of a trial that investigated the use of CD133+ BMCs implanted transepicardially and trans-septally during the coronary artery bypass graft (CABG) procedure in order to improve cardiac function [15]. They reported a significant increase (p=0.04) in EF at six months post-CABG in the group that received CD133+ BMCs against the group that received CABG alone [15].…”

“…Favorable findings in the treatment group bring to light a new research area of studying stem cell therapies with concomitant administration of G-CSF and other colonystimulating factors as well. Soestina et al, with a smaller cohort of 26 patients in a single-blind randomized control trial that used CD133+ cells, brings forward the importance of researching lineage-specific BMC as it showed a significant and favorable outcome in HF [15]. Frljak et al represented the sub-study of a larger randomized study.…”

“…While older studies failed to demonstrate any significant clinical improvement in parameters such as left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), recently published studies have shown improvement of cardiac function following stem cell therapy in HF patients [9][10][11][12][13][14][15].…”

The Role of Endothelial Progenitor Cells in Coronary Artery Disease: Basic Molecular Mechanisms and Its Clinical Potentials

“…CD133(+) progenitor cells improve cardiac function and repair the myocardium by stimulating neovascularization and angiogenesis. (55) Later, phase II ACT34-CMI Study was published in 2011 enrolling a total of 167 "no-option" RA patients. (56) This study evaluated 2 doses, 1×10 5 and 5×10 5 cells/ kg, for 12 months.…”