Early Increase in Myocardial Perfusion After Stem Cell Therapy in Patients Undergoing Incomplete Coronary Artery Bypass Surgery

Abstract

Incomplete revascularization is associated with worse long-term outcomes. Autologous bone marrow cells (BMC) have recently been tested in patients with severe coronary artery disease. We tested the hypothesis that intramyocardial injection of autologous BMC increases myocardial perfusion in patients undergoing incomplete coronary artery bypass grafting (CABG). Twenty-one patients (19 men), 59 ± 7 years old, with limiting angina and multivessel coronary artery disease (CAD), not amenable to complete CABG were enrolled. BMC were obtained prior to surgery, and the lymphomonocytic fraction separated by density gradient centrifugation. During surgery, 5 mL containing 2.1 ± 1.3 × 108 BMC (CD34+ = 0.8 ± 0.3%) were injected in the ischemic non-revascularized myocardium. Myocardial perfusion was assessed by magnetic resonance imaging (MRI) at baseline and 1 month after surgery. The increase in myocardial perfusion was compared between patients with <50% (group A, n = 11) with that of patients with >50% (group B, n = 10) of target vessels (stenosis ≥ 70%) successfully bypassed. Injected myocardial segments included the inferior (n = 12), anterior (n = 7), and lateral (n = 2) walls. The number of treated vessels (2.3 ± 0.8) was significantly smaller than the number of target vessels (4.2 ± 1.0; P < 0.0001). One month after surgery, cardiac MRI showed a similar reduction (%) in the ischemic score of patients in group A (72.5 ± 3.2), compared to patients in group B (78.1 ± 3.2; P = .80). Intramyocardial injection of autologous BMC may help increase myocardial perfusion in patients undergoing incomplete CABG, even in those with fewer target vessels successfully treated. This strategy may be an adjunctive therapy for patients suffering from a more advanced (diffuse) CAD not amenable for complete direct revascularization.

Direct intracardiac injection of umbilical cord-derived stromal cells and umbilical cord blood-derived endothelial cells for the treatment of ischemic cardiomyopathy

“…Ischemic cardiomyopathy (IC) involves changes in the cardiac structure, including thinning of the infarcted wall, cardiac dilatation, remodeling due to apoptosis and necrosis of cardiac myocytes, hypertrophy, fibrosis, and the infiltration of inflammatory cells. 4,5 Cell therapy has shown promising results in several preclinical studies [6][7][8][9][10] and clinical trials [11][12][13][14] that have reported the safety and efficacy of cell transplantation for a wide range of therapeutic applications. Stem/progenitor cellbased therapies have been demonstrated to be effective for tissue engineering and have potential applicability for therapeutic neovascularization, vascular repair, and tissue engineering.…”

In situmaturated early-stage human induced pluripotent stem cell-derived cardiomyocytes improve cardiac function by enhancing segmentary contraction in infarcted rats

“…In the last decades our group has worked to developing stem cell-based therapies to treat myocardial infarction building tools [35][36][37][38] and testing trending therapies [9,11,12,39,40] always aiming patients [6][7][8]. Adult stem cell approaches to treat MI have yet to yield relevant results clinically [41] and it is generally accepted that other approaches are needed [42].…”

“…Alternatively, stem cell-based therapies have been proposed to overcome the lack of heart re-muscularization within the available therapeutics [5]. Remarkably, multipotent stem cells isolated from adult tissues such as bone marrow [6][7][8][9][10] and adipose tissue [11,12] have demonstrated unsatisfactory heart regeneration performance. Conversely, human pluripotent stem cells such as embryonic stem cells (hESCs) [13] and induced pluripotent stem cells (hiPSCs) [14,15] are promising sources for generating cardiomyocytes (hPSC-CMs) in vitro [16,17].…”

Myocardial revascularization in the XXI century

“…Alternative procedures, such as using laser beams [58], stem cells [59] and even variations in the use of internal thoracic artery [60] have been described, but are part of the treatment of a special group of patients, which is certainly not fit into the daily routine.…”