Report of unexpected findings after cardiac stem cell injections in a preclinical model

Abstract

Introduction Cardiac regenerative therapy is a proposed therapy for ischemic heart disease. So far efficacy has been low and this might partly be explained by low cardiac cell retention. In this study we aimed to investigate if cardiac cell retention improves using ureido-pyrimidinone units (UPy-gel) as a cell carrier. Methods We used an ischemia-reperfusion model. Pigs were randomized to intramyocardial injections with mesenchymal stromal cells (MSC) labelled with both Indium-111 and a fluorescent tracer in either PBS or in the UPy-gel. After 4 hours, a total body scintigraphy was performed to determine the cardiac cell retention and histology was obtained. Results In the first 4 pigs, we noticed focused areas of radio activity (hotspots) outside the heart in both the control and UPy-gel arm, and decided to interrupt the study. At histology we confirmed one hotspots to be located in a lymph node. No satisfactory explanation for these, potentially harmful, hotspots was found. Conclusion This study was interrupted due to unexpected extra-cardiac hotspots. Although we do not have a conclusive explanation for these findings, we find that sharing these results is important for future research. We recommend to use total body imaging in future retention studies to confirm of reject the occurrence of extra-cardiac cell accumulation after intramyocardial cell injection and discover the pathophysiology and its clinical implications.