Intramyocardial Stem Cell Injection in Patients With Ischemic Cardiomyopathy

Abstract

Rationale Transcatheter, intramyocardial injections of bone marrow derived cell therapy produces reverse remodeling in large animal models of ischemic cardiomyopathy. Objective We used cardiac magnetic resonance imaging (CMR) in patients with LV dysfunction related to remote myocardial infarction (MI) to test the hypothesis that bone marrow progenitor cell injection cause functional recovery of scarred myocardium and reverse remodeling. Methods and Results Eight patients (age 57.2±13.3) received transendocardial, intramyocardial injection of autologous bone marrow progenitor cells (mononuclear or mesenchymal stem cells) in LV scar and border zone. All patients tolerated the procedure with no serious adverse events. CMR at 1-year demonstrated a decrease in end-diastolic volume (208.7±20.4 vs. 167.4±7.32mL; p=0.03), a trend towards decreased end-systolic volume (142.4±16.5 vs. 107.6±7.4mL; p=0.06), decreased infarct size (p<0.05), and improved regional LV function by peak Ecc in the treated infarct zone (-8.1±1.0 vs. -11.4±1.3; p=0.04). Improvements in regional function were evident at 3 months, while the changes in chamber dimensions were not significant until 6 months. Improved regional function in the infarct zone strongly correlated with reduction of EDV (r2=0.69, p=0.04) and ESV (r2=0.83, p=0.01). Conclusions These data suggest that transcatheter, intramyocardial injections of autologous bone marrow progenitor cells improve regional contractility of a chronic myocardial scar and these changes predict subsequent reverse remodeling. The findings support the potential clinical benefits of this new treatment strategy and ongoing randomized clinical trials.

Myocardial Self-Repair and Congenital Heart Disease

“…Intra-myocardial injection of autologous bone marrow derived stem cells has been used in adults with chronic ischemic heart disease (i.e. not infarcted) to achieve functional recovery and reverse ventricular remodeling (Williams et al, 2011). Such reports of success strengthen the concept that endogenous stem cells can provide clinically significant benefits to heart disease patients of all ages.…”

Stem cells; mesenchymal stem cells and current clinical applications

“…Williams ve ark. [46] ise 2011 yılın-da kronik iskemik kalp hastalı¤ı (K‹KH) olan sekiz hastaya miyokard içine otolog K‹-MKH vermi, bölgesel olarak kasılabilirli¤inin arttı¤ını ve diyastol/sistol sonu hacimlerin küçüldü¤ünü gözlemlemilerdir. [46] Mathiasen ve ark.…”

“…[46] ise 2011 yılın-da kronik iskemik kalp hastalı¤ı (K‹KH) olan sekiz hastaya miyokard içine otolog K‹-MKH vermi, bölgesel olarak kasılabilirli¤inin arttı¤ını ve diyastol/sistol sonu hacimlerin küçüldü¤ünü gözlemlemilerdir. [46] Mathiasen ve ark. [47] tarafından 2015 yılında yapılan randomize çift-kör ve plasebo-kontrollü bir çalımada, iskemik kalp yetmezli¤i olan 30 ila 80 ya aralı¤ında bulunan 37 hastaya miyokard içine otolog K‹-MKH, 18 hastaya ise plasebo verilmitir.…”

Stem cell therapies and regenerative medicine in China

“…At the same time, the clinical application of MSCs continues to increase markedly. Recently, numerous studies have revealed a variety of mechanisms including paracrine effects, neoangiogenesis, and biomechanical alterations because of scarring [16][17][18]. Moreover, MSCs have been widely tested for their capacity to mitigate autoimmunity.…”