Intracoronary bone marrow cell transfer after myocardial infarction: 5-year follow-up from the randomized-controlled BOOST trial

Abstract

A single intracoronary application of BMCs does not promote a sustained improvement of LVEF in STEMI patients with relatively preserved systolic function. It is conceivable that a subgroup of patients with more transmural infarcts may derive a sustained benefit from BMC therapy. However, this needs to be tested prospectively in a randomized trial.

Efficacy and Safety of Intracoronary Autologous Bone Marrow‐Derived Cell Transplantation in Patients With Acute Myocardial Infarction: Insights From Randomized Controlled Trials With 12 or More Months Follow‐Up

“…3 -11 However, it remains controversial whether the short-term benefits of BMC transplantation could last for more than 12 months. The Bone Marrow Transfer to Enhance ST-Elevation Infarct Regeneration trial (BOOST) suggested that BMC therapy did not improve LVEF at 5-year follow-up, 12 while the Clinical Benefit and Long-Term Outcome After Intracoronary Autologous Bone Marrow Cell Transplantation in Patients With Acute Myocardial Infarction (BALANCE) study showed a long sustained benefit of BMC treatment. 13 In this systematic review referring randomized controlled trials with 12 months or longer follow-up data, we analyzed the chronic efficacy of intracoronary autologous BMC in patients with acute MI.…”

Prompt Bone Marrow-Derived Mesenchymal Stem Cell Therapy Enables Early Porcine Heart Function Recovery from Acute Myocardial Infarction

“…Surprisingly, the influence of the timing of intracoronary BMDMNC delivery on LV function in patients with AMI undergoing primary PCI has infrequently been analyzed. Interestingly, a systemic review 40) has revealed that, compared with emergent transfusion (within 24 hour post-AMI) of BMDMNCs (ie, emergent transfer trials), [41][42][43] BMDMNC transfer at 4 to 7 days post-AMI 5,8,9) (ie, early trials) was superior to that within 24 hours in improving LV function and decreasing LV end-systolic dimensions. However, practically, because early cell delivery may not be possible for the majority of patients, the efficacy of autologous BM-DMNC delivery at either 3 days or 7 days or 2 to 3 weeks post-MI has been investigated by the TIME randomized trial 16) and the Late TIME randomized trial.…”

“…44) The particularly noteworthy finding in the present study is that rapid implantation of BM-DMSC significantly improved the heart function after permanent AMI in the mini-pig model. Thus, we suggest that more clinical trials are needed to elucidate whether earlier BMDM-NC treatment compared with the timing reported in the current studies 5,8,9,16,[41][42][43][44] (ie, BMDMNC transfer at 4 to 7 days post-AMI) could provide an additional benefit of improving heart function and clinical outcome in patients after AMI. Our new findings with promising results (ie, very early treatment with BMDMNCs after onset of AMI) may, at least partially, support our suggestion.…”

“…[6][7][8][9] Indeed, some studies have reported that SC therapy exhibited only temporary 5,8,9) or minimal 10) effectiveness, or was even ineffective [11][12][13][14][15][16] in improving global LV ejection fraction (LVEF) in patients after acute myocardial infarction (AMI). Further analysis of these clinical trials revealed that stem cell therapy was performed only several days after 5,8,9,[11][12][13] rather than immediately after AMI. Thus, interpretation of the results of these experimental and clinical investigations are difficult because of multiple variables, including the differences in experimental and trial design, cell type used, timing of cell delivery, and parameters for outcome assessment.…”

“…Thus, interpretation of the results of these experimental and clinical investigations are difficult because of multiple variables, including the differences in experimental and trial design, cell type used, timing of cell delivery, and parameters for outcome assessment. [1][2][3][4][5][6][7][8][9][10][11][12][13]17) To date, although there is still no definite explanation to account for the discrepancy in findings in the literature, [1][2][3][4][5][6][7][8][9][10][11][12][13] it is rational to believe that two factors are crucial in the success of SC therapy in improving ischemia-related LV dysfunction based on the results of previous reports, 4,5,[7][8][9][10][11][12][13] in other words, a larger number of SCs to be implanted 5,11,18) and an early timing of implantation [19][20][21] in the ischemic zone after AMI. Although small animals are frequently utilized in AMI experimentation Vol 55 No 4 STEM CELL ENABLES EARLY HEART FUNCTION RECOVERY for assessing the effect of stem cell therapy on heart function, an ...…”