Three-, 6-, and 12-month results of autologous transplantation of mononuclear bone marrow cells in patients with acute myocardial infarction

Sun

et al. 2010

Clinical Cardiology

Background: Until now there was no systematic review concerning the chronic effects of intracoronary bone marrow-derived cell (BMC) transplantation in patients with acute myocardial infarction (MI). Hypothesis: Improvement of cardiac function in patients with acute MI post BMC transplantation might last longer than 12 months. Methods: We searched MEDLINE, EMBASE, and the Cochrane database through June 2009. Eligible studies were randomized controlled trials of intracoronary BMC transfer in acute MI patients with follow-up duration equal to or longer than 12 months. Results: A total of 8 trials involving 725 participants were identified. Compared with controls, BMC transplantation significantly improved left ventricular ejection fraction (LVEF) by 4.37% (95% confidence interval [CI]: 2.66%-6.08%; P < 0.00001), reduced left ventricular end-diastolic volume (LVEDV) by 5.71 mL (95% CI: 2.03-9.40 mL; P = 0.002), left ventricular end-systolic volume (LVESV) by 8.94 mL (95% CI: 4.22-13.66 mL; P = 0.0002), and infarct size by 2.42% (95% CI: 1.33%-3.51%, P < 0.00001). Bone marrowderived cell treatment also significantly reduced the risk of death (relative risk [RR]: 0.33, 95% CI: 0.13-0.89; P = 0.03), while the risk of reinfarction was similar between the 2 groups (RR: 0.62, 95% CI: 0.09-4.12; P = 0.62). Subgroup analysis showed that the BMC transplantation-induced LVEF increase was more significant in patients age <55 and with cells transferred 6 or 7 days after MI. Conclusion: Beneficial effects of intracoronary BMC transplantation could last more than 12 months in acute MI patients.

Section: Selected Studies and Characteristicsmentioning

confidence: 99%

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

Sun

et al. 2010

Clinical Cardiology

“…Of these, 622 were nonrandomized studies, editorials, or reviews, and 83 of these were examined in more detail. Seventeen of the 83 references were eligible for inclusion [2][3][4][5][6][7][19][20][21][22][23][24][25][26][27][28][29] (Figure 1). …”

Section: Search Resultsmentioning

confidence: 99%

The effect of rigorous study design in the research of autologous bone marrow-derived mononuclear cell transfer in patients with acute myocardial infarction

et al. 2013

Introduction: Although blinding is a methodologic safeguard to ensure obtaining comparability of groups in a clinical trial, it is very difficult to maintain blinding from the beginning to the end of a study. The aim of the study was to see how proper blinding of both participants and treatment providers from the planning phase of the study to during the study affected the study outcomes. Methods: We searched Medline, EMBASE, and Cochrane databases from inception to November 2011. The studies included in this review were randomized controlled trials, with acute myocardial infarction (AMI) patients who received percutaneous coronary intervention (PCI), intracoronary (IC) infusion of autologous bone marrow stem cells (BMSCs), unselected BMSCs, 10 8 or more cell dose, and up to 6-month follow-up periods.

“…There has been controversy over the possible efficacy and mechanism of BM treatment of MI focused around the persistence and function of stem cells in the myocardium [7,8,35], with findings both dismissing and supporting the trans-differentiation of non-cardiac lineage stem cells into functional cardiomyocytes and endothelial tissue. Despite these contradictions, there is a growing body of data from studies of bone marrow derived cell transplantation post-MI in animal models [9,[36][37][38] and human clinical trials [2,14,23,[39][40][41][42] that show improvements in heart function over the short and long term consistent enough to be retained in extensive meta-analysis [24]. The variability in reported data highlight the need to better understand what makes some cellular therapies successful whilst others effect no improvement.…”

Section: Discussionmentioning

confidence: 99%

Hematopoietic stem cells are a critical sub-population of whole bone marrow in the treatment of myocardial infarction

Davy¹,

Walker²,

Wong³

et al. 2013

SCD

Recent studies suggest that whole bone marrow (WBM) derived stem cells may facilitate recovery following myocardial infarction. However, the sub-population of WBM responsible for recovery remains uncertain. By adjusting the abundance of CD34 + LinNeg cells in human bone marrow we examined the relative significance of hematopoietic stem cells (HSC) in the recovery of cardiac function in a murine model of induced myocardial infarction. Enrichment of HSC by ~100-fold in WBM transplanted into mice significantly increased recovery of heart function and reduced scar size compared to transplantation of WBM depleted in HSC by ~10-fold (P < 0.05, and P < 0.01 respectively). Peri-infarct capillary density was significantly increased in recipients of HSC-enriched samples (P < 0.01) or WBM samples (P < 0.01) compared to controls. These results strongly suggest a critical role for HSC in the effective treatment of myocardial infarction with human bone marrow, and imply that enrichment of HSC may markedly benefit the clinical application of WBM treatments.