Intracoronary Injection of CD133-Positive Enriched Bone Marrow Progenitor Cells Promotes Cardiac Recovery After Recent Myocardial Infarction

Abstract

Background— Bone marrow CD133-postive (CD133 + ) cells possess high hematopoietic and angiogenic capacity. We tested the feasibility, safety, and functional effects of the use of enriched CD133 + progenitor cells after intracoronary administration in patients with recent myocardial infarction. Methods and Results— Among 35 patients with acute myocardial infarction treated with stenting, 19 underwent intracoronary administration of CD133 + progenitor cells (12.6±2.2×10 6 cells) 11.6±1.4 days later (group 1) and 16 did not (group 2). At 4 months, left ventricular ejection fraction increased significantly in group 1 (from 45.0±2.6% to 52.1±3.5%, P <0.05), but only tended to increase in case-matched group 2 patients (from 44.3±3.1% to 48.6±3.6%, P =NS). Likewise, left ventricular regional chordae shortening increased in group 1 (from 11.5±1.0% to 16.1±1.3%, P <0.05) but remained unchanged in group 2 patients (from 11.1±1.1% to 12.7±1.3%, P =NS). This was paralleled by reduction in the perfusion defect in group 1 (from 28.0±4.1% to 22.5±4.1%, P <0.05) and no change in group 2 (from 25.0±3.0% to 22.6±4.1%, P =NS). In group 1, two patients developed in-stent reocclusion, 7 developed in-stent restenosis, and 2 developed significant de novo lesion of the infarct-related artery. In group 2, four patients showed in-stent restenosis. In group 1 patients without reocclusion, glucose uptake shown by positron emission tomography with 18 fluorodeoxyglucose in the infarct-related territory increased from 51.2±2.6% to 57.5±3.5% ( P <0.05). No stem cell-related arrhythmias were noted, either clinically or during programmed stimulation studies at 4 months. Conclusion— In patients with recent myocardial infarction, intracoronary administration of enriched CD133 + cells is feasible but was associated with increased incidence of coronary events. Nevertheless, it seems to be associated with improved left ventricular performance paralleled with increased myocardial perfusion and viability.

Combining stem cells in myocardial infarction: The road to superior repair?

“…However, no comparison was made with a control group. In accordance with these results, intracoronary infusion of CD34 + 63 and CD133 + 63,64 EPCs in other studies also improved LVEF compared to baseline. It should be noted that these significant improvements are only small increases in LVEF of ~3%–7%, indicating a poor clinical relevance.…”

“…It should be noted that these significant improvements are only small increases in LVEF of ~3%–7%, indicating a poor clinical relevance. Unfortunately, intracoronary administration of CD133 + EPCs resulted in higher restenosis rates and increased risk for atherosclerosis 64,65 . Nonetheless, comparison of results between clinical trials is difficult because of the variability of the used EPC subtype 100 …”

“…Unfortunately, intracoronary administration of CD133 + EPCs resulted in higher restenosis rates and increased risk for atherosclerosis. 64,65 Nonetheless, comparison of results between clinical trials is difficult because of the variability of the used EPC subtype. 100…”

Kombinasi Alat Cardiac Contractility Modulation dan Terapi Sel Punca Hematopoetik CD34+CD133+ sebagai Terapi Gagal Jantung dengan Penurunan Fraksi Ejeksi

“…37 Akan tetapi, stem cell dikembangkan tidak hanya untuk fungsi mekanis atau elektris menggantikan peran miokardium yang rusak, tetapi juga menjadi bagian dari sistem seluler-biomolekuler yang mendukung sistem perbaikan jaringan endogen. 37,38 Mekanisme parakrin stem cell melibatkan banyak target, di antaranya stimulasi angiogenesis, atenuasi fibrosis, inflamasi, dan apoptosis, rekrutmen dari tissueresident stem/progenitor cells yang secara sinergistik dengan koreksi kontraktilitas oleh CCM dapat meningkatkan proteksi jaringan dan memelihara fungsi jantung. 38 Sel punca hematopoietik (HSC) dan sel progenitor endothelial (EPC) adalah jenis sel punca dewasa; keduanya mengekspresikan reseptor permukaan transmembran CD34 + dan CD133 + yang digunakan sebagai penanda untuk pengayaan jumlah dari galur sel tersebut dengan memobilisasi sumsum tulang.…”

“…37,38 Mekanisme parakrin stem cell melibatkan banyak target, di antaranya stimulasi angiogenesis, atenuasi fibrosis, inflamasi, dan apoptosis, rekrutmen dari tissueresident stem/progenitor cells yang secara sinergistik dengan koreksi kontraktilitas oleh CCM dapat meningkatkan proteksi jaringan dan memelihara fungsi jantung. 38 Sel punca hematopoietik (HSC) dan sel progenitor endothelial (EPC) adalah jenis sel punca dewasa; keduanya mengekspresikan reseptor permukaan transmembran CD34 + dan CD133 + yang digunakan sebagai penanda untuk pengayaan jumlah dari galur sel tersebut dengan memobilisasi sumsum tulang. Sel-sel derivat sumsum tulang terutama subpopulasi C133 + mampu memicu angiogenesis, sehingga dipercaya dapat bermanfaat bagi jantung yang mengalami iskemia miokard.…”