Autological Cell Therapy and Its Role in the Treatment of Refractory Angina

Abstract

The first clinical studies dedicated to the use of autological mesenchymal stem сells(MSCs) for the treatment of angina by means of their intravenous and transendocardialinjection is carried out in State Institution «Institute of Urgent and Recovery Surgerynamed after V.K. Gusak of National Academy of Medical Science of Ukraine» since 2007.The effectiveness of autological mesenchymal stem cells (MSCs) was researched in 60patients, and it was established that injection of 50 million of cells per a person withrefractory angina is an effective and a safe method of treatment. The results of clinicalresearch have shown that the delivery of MSCs to the lesion provides restoring ofmyocardial function and influences on the left ventricular remodeling.Objective – to substantiate the effectiveness of autological MSCs in the treatment ofrefractory angina.Material and methods. The results of examination, treatment and observation of 60patients with refractory angina (52 men and 8 women aged from 46 to 70 years) since2007 to 2012 are performed in the article.Results. We obtained the following data while studying of the dynamics of left ventricularend diastolic volume (LVEDV), which is a prognostic factor of the course of heart failure(HF). The decrease of LVEDV from 248.5 ± 22.3 to 194.3 ± 26.4 ml was observed inthe group of patients 3 months later after endocardial injection. This rate was stable 6months later after an injection, but lower than the initial one (p value > 0.05). A similartrend was observed in the group of intravenous injection . LVEDV decreased from 244.1± 24.3 to 193.4 ± 18.9 ml within 3 months and remained stable up to 6 months but lowerto the rate that was observed before the treatment with a trend to increasing to the initiallevel. Ultrasound studying of the left ventricular ejection fraction (LVEF) in patients of transendocardial injection of cell transplant showed an increasing of LVEF from 41.3 ±3.2 to 49.3 ± 4.6% 3 months later after the procedure and it was stable up to 6 months ofthe posttransplant period. LVEF is also increased in the group of intravenous transplantadmission (from 33.8 ± 3.6 to 42.8 ± 4.8%) after procedure, with its gradually decreasingin terms of 3 months, LVEF approaches the starting values up to 6 months after celltransplantation.Conclusions. The received clinical data have shown that MSCs facilitate the restoringof mechanical myocardial function and influence left ventricular remodeling aftertheir admission to the lesion zone. This effect has been confirmed according to cardiacechocardiography, treadmill-test, electromechanical mapping of the LV. The positiveeffect was remaining for 6 months. The received data allows to recommend the clinicaluse of biotechnology in ischemic heart disease treatment.