Intracoronary Stem Cell Infusion in Heart Transplant Candidates

Abstract

The stem cell transplantation is emerging as a potential therapeutic modality for patients with heart failure. It has been demonstrated that intracoronary stem cell transplantation had beneficial effects on left ventricular perfusion and contractile functions. We hypothesized that patients with end-stage ischemic cardiomyopathy, who are candidates for heart transplantation, could also benefit from autologous intracoronary stem cell transplantation. We performed a prospective, openlabeled study in 10 patients with end-stage ischemic cardiomyopathy, who were on the waiting list for heart transplantation. Each patient received bone marrow-derived mononuclear cell infusion via balloon catheter in the target vessel, which had been revascularized by percutaneous intervention and was patent before the procedure. Clinical and laboratory evaluations, a treadmill exercise test, echocardiography, and single photon emission tomography (SPECT) were performed to the patients at baseline and 6 months after stem cell infusion. At 6-month follow-up of the eight patients who were able to complete the study, we revealed a significant increase in ejection fraction (from 30.0 ± 6.6% to 36.2 ± 7.3%; p = 0.001) in echocardiographic evaluation. SPECT evaluation also displayed a reduction in infarct area (50.4 ± 16.1% to 44.1 ± 12.5%; p = 0.003). Both myocardial oxygen consumption ( p = 0.001) and metabolic equivalents ( p = 0.001) were significantly increased at 6-month follow-up. These results demonstrate that intracoronary stem cell transplantation ameliorates heart failure symptoms and improves left ventricular function and perfusion. Therefore intracoronary stem cell transplantation may be used as an alternative treatment option for heart transplant candidates. cellular cardiomyoplasty; heart transplant candidates; intracoronary infusion; stem cells; ischemic cardiomyopathy © 2007 Tohoku University Medical PressCongestive heart failure (CHF) of ischemic origin remains to be a major clinical problem despite major advances in medical and surgical treatment of patients with myocardial infarction (MI) both during acute and chronic phases. In the acute setting of MI, revascularization procedures,

Association between in vivo bone formation and ex vivo migratory capacity of human bone marrow stromal cells

“…Human skeletal stem cells (also known as human bone marrow-derived stromal cells (hBMSC)) are adult multipotent stem cells located in the bone marrow perivascular niche and are recruited to bone formation sites during bone remodeling [ 1 ]. During recent years, hBMSC have been tested in a number of clinical trials for their ability to enhance tissue repair including tissue regeneration where hBMSC were injected locally at the sites of tissue injury; for example, bone fracture [ 2 – 4 ] or ischemic myocardium [ 5 – 8 ]. However, systemic intravenous infusion is more suitable for clinical cell transplantation and is employed for hematopoietic stem cell (HSC) transplantation with success and where HSCs, following homing from systemic circulation to bone marrow, engraft and initiate hematopoiesis [ 9 ].…”

Evolving cell-based therapies for heart failure patients

“…No adverse events related to the procedure were found, and no arrhythmias were reported. Therefore, this group also concluded that the procedure is safe [ 44 ]. • The only randomized controlled study of cell-based therapy in HF patients to date is the TOPCARE-CHD (Transplantation of Progenitor Cells and Recovery of Left Ventricular Function in Patients With Nonischemic Dilatative Cardiomyopathy) trial of 75 patients with a history of MI at least 3 months before the start of the study and regional left ventricular dysfunction.…”