Abstract
Experimental and clinical data show that bone marrow-derived stem cells (BMSC) can contribute to myocardial regeneration after ischemic injury. We present results of intracoronary infusion of autologous BMSCs in treatment of patients (pts) with acute myocardial infarction (MI). 36 pts with first, anterior wall MI, successfully treated with percutaneous coronary angioplasty were enrolled into the study. 24 pts, aged 50.1±9.05 yrs received intracoronary BMSC infusion 4 to 7 days after MI. Control group consisted of 12 pts, aged 51.6±8.7 yrs. In BMSC group BM in total volume 80 (50–150) ml was collected from iliac crest to buffered saline with heparine. After isolation and 18–24 hrs cultivation BMSCs were resuspended in autologous plasma in final volume 12.25±2.05 ml. The mean number of MNC, CD34+, CD133+/CD45+ and CD133+/CD45− cells were respectively: 0.41±0.18x10e9, 3.89±1.45x10e6, 0.96±0.6x10e6, 0.15±0.1x10e6. Transplanted material was divided into 3–5 portion and injected directly to infarcted area (Strauer method). Left ventricular function was evaluated by echocardiography (contactility index, CI), Tc-99 MIBI SPECT (perfusion index, PI) at rest (R) and with dipiridamol (D) and radionuclide ventriculography (ejection fraction, EF) at baseline and after 3, 6, 12 months (mo). CI and PI were assessed in left ventricle and infarct related artery (IRA) area. Control coronary angiography was performed after 6 mo. No adverse effects of BM aspiration in early MI were observed. One pts revealed chills and fever and 1 acute pulmonary oedema after cell infusion. Control angiography revealed restenosis in 3 pts from BMSC and 2 from control group. Results of cardiac test are presented in table.
Conclusions: Intracoronary autologous BMNCs transplantation is safe and feasible. Improvement of left ventricular function was observed in BMSC group, mainly concerning perfusion. No accelerated atherosclerosis was seen after intracoronary BMSC administration.
Results of cardiac tests BMSC group Control group p CI/CI-IRA 7 day 1.62±0.19/2.3±0.36 1.6±0.24/2.21±0.41 ns CI/CI-IRA 3 mo 1.55±0.2/2.12±0.4 1.65±0.3/2.34±0.64 ns CI/CI-IRA 6 mo 1.5±0.2/2.16±0.37 1.7±0.29/2.46±0.51 0.02 CI/CI-IRA 12 mo 1.55±0.2/2.24±0.44 1.72±0.33/2.48±0.51 ns Pi/PI-IRA-R 10 day 2.45±0.63/2.96±0.88 2.45±0.53/3.04±0.74 ns PI/PI-IRA-R 3 mo 2.25±0.37/2.79±0.61 2.36±0.44/2.88±0.61 ns PI/PI-IRA-R 6 mo 2.19±0.43/2.68±0.67 2.43±0.32/3.02±0.45 0.07 PI/PI-IRA-R 12 mo 2.11±0.33/2.63±0.46 2.36±0.31/2.98±0.46 ns PI/PI-IRA-D 10 day 2.45±0.63/2.96±0.88 2.45±0.53/3.04±0.74 ns PI/PI-IRA-D 3 mo 2.3±0.42/2.87±0.67 2.43±0.4/2.93±0.44 ns PI/PI-IRA-D 6 mo 2.2±0.44/2.58±0.83 2.48±0.43/3.12±0.48 0.06 PI/PI-IRA-D 12 mo 2.16±0.43/2.59±0.6 2.57±0.44/3.35±0.42 0.009 EF 4 day 45.0±7.9 41.6±6.6 ns EF 6 mo 48.2±9.2 42.1±11.4 0.07 EF 12 mo 48.5±4.9 38.9±7.7 0.002
Intracoronary administration of autologous adipose tissue-derived stem cells improves left ventricular function, perfusion, and remodelling after acute myocardial infarction
