Transmurality of scar influences the effect of a hybrid-intervention with autologous bone marrow cell injection and aortocoronary bypass surgery (MNC/CABG) in patients after myocardial infarction
Transmurality of scar influences the effect of a hybrid-intervention with autologous bone marrow cell injection and aortocoronary bypass surgery (MNC/CABG) in patients after myocardial infarction
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DOI：
10.1016/j.ijcard.2010.11.010
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发表时间：
2012-05-03
影响因子：
3.5
通讯作者：
Erdmann, Erland
中科院分区：
文献类型：
--
作者：
Mueller-Ehmsen, Jochen;Tossios, Paschalis;Erdmann, Erland
背景：细胞疗法（CTx）是一种支持心肌梗死（MI）后心脏再生的策略。到目前为止，临床研究得出的结果好坏参半。在这里，我们调查了梗塞的透壁性是否可能发挥相关作用。方法：18 例患者（63+/-3 岁，15 名男性）在 MI 后 2.2+/-0.7 个月接受选择性冠状动脉旁路移植术 (CABG) 手术参与。通过 Tc-99m-MIBI 单光子发射计算机断层扫描 (SPECT) 和 F18-FDG-正电子发射断层扫描 (PET) 评估，10 例有透壁梗塞疤痕，8 例有非透壁梗塞疤痕。手术期间，获得10ml胸骨骨髓，分离单核细胞(MNC)。手术结束时，将MNC注射到梗塞的中心和边缘区域（注射10次，总共2ml，6.6+/-1.3 x 10(7) MNC）。结果：没有观察到细胞治疗引起的主要并发症。治疗后3个月和24个月，非透壁性疤痕尺寸减小（7.7+/-1.1%和5.5+/-1.8 vs. 17.5+/-4.9%，P=0.05和P=0.04），而透壁性疤痕保持不变（23.5+/-2.6%和23.8+/-3.2 vs. 23.5+/-2.6%，P>0.99和P=0.95）。非透壁性疤痕患者的 LVEF 呈改善趋势（MRI：48.8+/-5.1% 对比 30.6+/-8.7%，P=0.3；SPECT：54.1+/-3.1 对比 41.0+/-4.0，P=0.086），但透壁性疤痕患者则没有改善的趋势（MRI：36.7+/-3.9 对比 30.6+/-3.9%，P=0.086）。 34.3+/-5.0，P=0.63，SPECT：37.8+/-3.1 vs. 37.9+/-2.3%，P=0.96)。结论：MNC 恢复、纯化和注射与 CABG 手术 (MNC/CABG) 的单一混合干预可能是细胞治疗的一种有吸引力的方式。然而，活体透壁疤痕组织似乎没有发生再生，而 MNC 对改善非透壁心肌梗塞疤痕灌注的贡献仍有待确定。 (C) 2010 Elsevier Ireland Ltd. 保留所有权利。
Background: Cell therapy (CTx) is a strategy to support cardiac regeneration after myocardial infarction (MI). Thus far, clinical studies provided mixed results. Here, we investigated whether transmurality of the infarct may play a relevant role.Methods: 18 patients (63+/-3 years, 15 male) undergoing elective coronary artery bypass graft (CABG) surgery 2.2+/-0.7 months post MI participated. 10 had transmural and 8 non-transmural infarct scars assessed by Tc-99m-MIBI Single-Photon Emission Computed Tomography (SPECT) and F18-FDG-Positron-Emission-Tomography (PET). During surgery, 10 ml of sternal bone marrow were obtained, mononuclear cells (MNC) were isolated. At the end of surgery MNC were injected into the infarctions' center and border zones (10 injections, 2 ml total, 6.6+/-1.3 x 10(7) MNC).Results: No major complications attributable to cell therapy were observed. The sizes of non-transmural scars were reduced at 3 and 24 months after treatment (7.7+/-1.1% and 5.5+/-1.8 vs. 17.5+/-4.9%, P=0.05 and P=0.04), while transmural scars remained unchanged (23.5+/-2.6% and 23.8+/-3.2 vs. 23.5+/-2.6%, P>0.99 and P=0.95). A trend towards improved LVEF was seen in patients with non-transmural scars (MRI: 48.8+/-5.1% vs. 30.6+/-8.7%, P=0.3; SPECT: 54.1+/-3.1 vs. 41.0+/-4.0, P=0.086), but not in patients with transmural scars (MRI: 36.7+/-3.9 vs. 34.3+/-5.0, P=0.63, SPECT: 37.8+/-3.1 vs. 37.9+/-2.3%, P=0.96).Conclusions: A single hybrid intervention of MNC recovery, purification and injection with CABG-surgery (MNC/CABG) may be an attractive modality for cell therapy. However, no regeneration of avital transmural scar tissue seems to occur, while the contribution of MNC to improved perfusion in non-transmural myocardial infarct scars remains to be determined. (C) 2010 Elsevier Ireland Ltd. All rights reserved.