Synergistic effects of intracoronary infusion of autologous bone marrow-derived mesenchymal stem cells and revascularization procedure on improvement of cardiac function in patients with severe ischemic cardiomyopathy

Abstract

Background: Ischemic cardiomyopathy (ICM) is a leading cause of cardiovascular mortality worldwide. It is defined as abnormal enlargement of the left ventricular (LV) cavity with poor LV function due to coronary artery disease. Currently available established treatments are palliative whereby blood supply is recovered to ischemic regions but fails to regenerate heart tissues. Mesenchymal stem cells (MSCs) offer a promising treatment for ICM given their regenerative and multipotent characteristics. This study aims to investigate the effect of MSCs infusion with concurrent revascularization in patients with severe ICM compared to receiving only revascularization procedure or MSCs infusion.Methods: Twenty-seven patients with history of anterior myocardial infarction (MI) and baseline left ventricular ejection fraction (LVEF) of less than 35% were recruited into this study. Patients who are eligible for revascularization were grouped into group A (MSCs infusion with concurrent revascularization) or group B (revascularization only) while patients who were not eligible for revascularization were allocated in group C to receive intracoronary MSCs infusion. LV function was measured using echocardiography.Results: Patients who received MSCs infusion (either with or without revascularization) demonstrated significant LVEF improvements at 3, 6 and 12 months post-infusion when compared to baseline LVEF within its own group. When comparing the groups, the magnitude of change in LVEF from baseline for third visits i.e., 12 months post-infusion was significant for patients who received MSCs infusion plus concurrent revascularization in comparison to patients who only had the revascularization procedure. Conclusions: MSCs infusion significantly improves LV function in ICM patients. MSCs infusion plus concurrent revascularization procedure worked synergistically to improve cardiac function in patients with severe ICM.

Clinical utility of mesenchymal stem/stromal cells in regenerative medicine and cellular therapy

“…Similarly, patients receiving BM-MSC infusion with revascularization showed improvement in left ventricle function in comparison to the group who only received the revascularization, as well as patients who received BM-MSC infusion via intracoronary administration. Together, these results demonstrate that MSC infusion significantly increases and improves cardiac function in CIC [ 138 ]. In a similar study, intramyocardial injection of either UC-MSCs or BM-MSCs along with coronary artery bypass grafting (CABG) surgery improved left ventricle function in patients as seen in 1, 3, 6, and 12 months follow-up.…”

“…Although insulin injections are effective in glycemic control, they fail to address the other side effects of T1D, such as nephropathy, high blood pressure, and foot diseases [ 138 ]. Thus, a permanent cure to T1D must address the autoimmune response, followed by an emphasis on islet regeneration and replacement.…”

Alteration of endothelial permeability ensures cardiomyocyte survival from ischemic insult in the subendocardium of the heart

“…11 At present, revascularization is considered to be one of the most important methods to promote myocardial regeneration. 12 Co-transplanting micro-vessels and pluripotent stem cell-derived cardiomyocytes helps cardiomyocyte survival in the ischemic myocardium. 13 It is, therefore, worthwhile that exploring changes in the microvascular network may be relevant to cardiomyocyte survival in the subendocardial region.…”

Mesenchymal stem cells: A new therapeutic tool for chronic kidney disease

“…In many previous studies, mesenchymal stem cells (MSCs) have been found to be safe and feasible for treating cardiomyopathy ( Chin et al, 2010 ; Chin et al, 2011 ; Chin et al, 2021 ), multiple myeloma ( Teoh et al, 2016 ), and DM ( Li et al, 2021 ). It is also reported as an effective treatment for fibrosis diseases, like liver fibrosis ( Eom et al, 2015 ), lung fibrosis ( Barczyk et al, 2015 ), as well as myocardial fibrosis ( Jin et al, 2020 ).…”