Autologous Bone-Marrow Mononuclear Cell Transplantation after Acute Myocardial Infarction: Comparison of Two Delivery Techniques

Abstract

The objective of this study was to investigate safety and feasibility of autologous bone marrow mononuclear cells (BMMNC) transplantation in ST elevation myocardial infarction (STEMI), comparing anterograde intracoronary artery (ICA) delivery with retrograde intracoronary vein (ICV) approach. An open labeled, randomized controlled trial of 30 patients admitted with STEMI was used. Patients were enrolled if they 1) were successfully reperfused within 24 h from symptoms onset and 2) had infarct size larger than 10% of the left ventricle (LV). One hundred million BMMNC were injected in the infarct-related artery (intraarterial group) or vein (intravenous group), 1% of which was labeled with Tc 99m -hexamethylpropylenamineoxime. Cell distribution was evaluated 4 and 24 h after injection. Baseline MRI was performed in order to evaluate microbstruction pattern. Baseline radionuclide ventriculography was performed before cell transfer and after 3 and 6 months. All the treated patients were submitted to repeat coronary angiography after 3 months. Thirty patients (57 ± 11 years, 70% males) were randomly assigned to ICA (n = 14), ICV (n = 10), or control (n = 6) groups. No serious adverse events related to the procedure were observed. Early and late retention of radiolabeled cells was higher in the ICA than in the ICV group, independently of microcirculation obstruction. An increase of EF was observed in the ICA group (p = 0.02) compared to baseline. Injection procedures through anterograde and retrograde approaches seem to be feasible and safe. BMMNC retention by damaged heart tissue was apparently higher when the anterograde approach was used. Further studies are required to confirm these initial data.

A safety and feasibility study of cell therapy in dilated cardiomyopathy

“…This confirms reported literature results indicating that intracoronary injection of bone marrow-derived cells is not arrhythmogenic (11,(14)(15)(16)24).…”

“…Since the pioneering work of Strauer et al (27), many groups have performed phase I/II trials showing the intracoronary delivery of autologous marrow cells to be safe and potentially effective (16,26,27). Larger randomized trials have confirmed the efficacy of this new therapy (28)(29)(30), although these results have been disputed (31).…”

“…Cell therapy using bone marrow-derived cells has been successfully applied to the treatment of acute and chronic ischemic heart disease (15,16,26). Since the pioneering work of Strauer et al (27), many groups have performed phase I/II trials showing the intracoronary delivery of autologous marrow cells to be safe and potentially effective (16,26,27).…”

“…In the clinical setting, cell therapies have been previously used in patients with ischemic heart disease, both in the acute and chronic stages. In most trials, the mononuclear fraction of bone marrow has been used, but a variety of cell types from bone marrow and skeletal myoblasts have also been delivered to patients (10)(11)(12)(13)(14)(15)(16)(17). Results have demonstrated excellent safety with encouraging signs of clinical improvement (10)(11)(12)(14)(15)(16)(17).…”

Injeção intracoronariana de células tronco após infarto do miocárdio: subestudo da microcirculação

“…This study was designed to answer questions on the release techniques and the consequent distribution of cells 19 . Its small sample size and its open-label nature prevent us from reaching definitive conclusions when evaluating subgroups 20 .…”