Impact of Intracoronary Cell Therapy on Left Ventricular Function in the Setting of Acute Myocardial Infarction

Lipinski, Michael J.; Biondi‐Zoccai, Giuseppe; Abbate, Antonio; Khianey, Reena; Sheiban, Imad; Bartúnek, Jozef; Vanderheyden, Marc; Kim, Hyo Soo; Kang, Hyun–Jae; Strauer, Bodo E.; Vetrovec, George W.

doi:10.1016/j.jacc.2007.07.041

Cited by 479 publications

(345 citation statements)

References 27 publications

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“…There were less reinfarctions, death, or HF hospitalizations in cell treated groups. 13 The EF increase is modest, sometimes transient, and less than expected compared to animal models (Figs. 1a and b).…”

Section: Timing Comparisonsmentioning

confidence: 86%

“…61,80 Landmark, large-scale trials using BMC showed benefits in neovascularization, ventricular function and remodeling. [12][13][14] The ACT-34 study demonstrated that EPC mobilization, isolation and injection significantly improved recurrent angina. 81 One-year results from the largest trial using allogeneic MSC post-AMI showed ventricular benefit, with significant decreases in HF and re-hospitalizations in the treated group.…”

Section: Dilated Cardiomyopathymentioning

confidence: 99%

“…1a and b). [12][13][14] Inconsistent results are attributable to the lack of standardization among trials in cell types used, dosages, delivery methods, timing, and follow-up. 7 Lastly, measured endpoints vary between studies.…”

Section: Timing Comparisonsmentioning

confidence: 99%

“…Inflammation, tumor formation, arrhythmias, and restenosis were not increased in the trials in which they were measured. [12][13][14] Use of adult allogeneic and autologous cells is considered to be without ethical concerns. 29 The only known contraindications for use of autologous cells include chronic infectious diseases, malignant solid tumors, and diseases of the bone marrow and stem cells.…”

Section: Timing Comparisonsmentioning

confidence: 99%

“…Clinical trials demonstrated feasibility and safety with positive results. [12][13][14] Benefits cannot be explained solely by stem cells, and are likely associated with paracrine factors released into injured tissue. This review explores emerging clinical applications of stem cell therapy as a promising approach for restoring myocardial function in heart disease.…”

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confidence: 99%

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Stem Cell Therapy for Heart Disease

2013

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Coronary artery disease is the leading cause of death in Americans. After myocardial infarction, significant ventricular damage persists despite timely reperfusion and pharmacological management. Treatment is limited, as current modalities do not cure this damage. In the past decade, stem cell therapy has emerged as a promising therapeutic solution to restore myocardial function. Clinical trials have demonstrated safety and beneficial effects in patients suffering from acute myocardial infarction, heart failure, and dilated cardiomyopathy. These benefits include improved ventricular function, increased ejection fraction, and decreased infarct size. Mechanisms of therapy are still not clearly understood. However, it is believed that paracrine factors, including stromal cell-derived factor-1, contribute significantly to stem cell benefits. The purpose of this article is to provide medical professionals with an overview on stem cell therapy for the heart and to discuss potential future directions.

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Section: Timing Comparisonsmentioning

confidence: 86%

Section: Dilated Cardiomyopathymentioning

confidence: 99%

Section: Timing Comparisonsmentioning

confidence: 99%

Section: Timing Comparisonsmentioning

confidence: 99%

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confidence: 99%

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Stem Cell Therapy for Heart Disease

2013

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Effect of Intracoronary Delivery of Autologous Bone Marrow Mononuclear Cells 2 to 3 Weeks Following Acute Myocardial Infarction on Left Ventricular Function

Traverse

Henry

Ellis

et al. 2011

JAMA

390

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Context Clinical trial results suggest that intracoronary delivery of autologous bone marrow mononuclear cells (BMCs) may improve left ventricular (LV) function when administered within the first week following myocardial infarction (MI). However, since a substantial number of patients may not present for early cell delivery, we investigated the efficacy of autologous BMC delivery 2–3 weeks post-MI. Objective To determine if intracoronary delivery of autologous BMCs improves global and regional LV function when delivered 2–3 weeks following first MI. Design, Setting, and Patients LateTIME is a randomized, double-blind, placebo-controlled trial of the National Heart, Lung, and Blood Institute - sponsored Cardiovascular Cell Therapy Research Network (CCTRN) of 87 patients with significant LV dysfunction (LVEF ≤ 45%) following successful primary percutaneous coronary intervention (PCI). Interventions Intracoronary infusion of 150 × 106 autologous BMCs (total nucleated cells) or placebo (2:1 BMC:placebo) was performed within 12 hours of bone marrow aspiration after local automated cell processing. Main Outcome Measures The primary endpoints were changes in global (LVEF) and regional (wall motion) LV function in the infarct and border zone from baseline to 6 months as measured by cardiac MRI at a core lab blinded to treatment assignment Secondary endpoints included changes in LV volumes and infarct size. Results 87 patients were randomized between July 2008 and February 2011: mean age = 57 ± 11 yrs, 83% male. Harvesting, processing, and intracoronary delivery of BMCs in this setting was feasible and safe. The change from baseline to six months in the BMC group, when compared to the placebo group, for LVEF (48.7 to 49.2% vs. 45.3 to 48.8%; Difference = −3.0, 95% CI −7.0 to 0.9), wall motion in the infarct zone (6.2 to 6.5 vs. 4.9 to 5.9 mm; Difference = −0.7, 95% CI −2.8 to 1.3), and wall motion in the border zone (16.0 to 16.6 mm vs. 16.1 to 19.3 mm; Difference = −2.6; 95% CI −6.0 to 0.8) were not statistically significant. There was no significant change in LV volumes and infarct volumes decreased by a similar amount in both groups at 6 months compared to baseline. Conclusions Among patients with MI and LV dysfunction following reperfusion with PCI, intracoronary infusion of autologous BMCs compared to intracoronary placebo infusion, 2–3 weeks after PCI did not improve global or regional function at 6 months.

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