Autologous CD133 + Cells and Laser Revascularization in patients with severe Ischemic Cardiomyopathy.
Autologous CD133 + Cells and Laser Revascularization in patients with severe Ischemic Cardiomyopathy.
复制标题
自体 CD133--细胞和激光血运重建治疗严重缺血性心肌病。
DOI：
10.1007/s12015-022-10479-w
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发表时间：
2023
影响因子：
4.8
通讯作者：
Sekela,MichaelE
中科院分区：
文献类型：
--
作者：
Abdel-Latif,Ahmed;Ahmed,Taha;Leung,SteveW;Alnabelsi,Talal;Tarhuni,Wadea;Sekela,MichaelE
目的我们验证了靶向TMLR联合心肌内注射自体CD 133+祖细胞对于慢性缺血性心肌病（ICM）且无血运重建选择的患者是安全可行的假设。方法纳入8名患有多支严重缺血性心脏病且无血运重建选择的男性患者（年龄62±2.4岁）。在手术当天使用临床级封闭式 CliniMACS 系统从骨髓中提取并纯化自体 CD 133++ 内皮祖细胞。采用侧胸切开术，进行TMLR，然后在TMLR位点周围区域对纯化的CD133++细胞（移植细胞的平均数：12.5×106）进行心肌移植。这些部位的选择是基于术前灌注成像的缺血情况。我们在手术前以及 6 个月和 12 个月的随访中进行了临床和心肌灌注成像。结果 手术期间或围手术期住院期间没有发生重大并发症或死亡。一名患者在手术后 6 个月因心脏病死亡。据报道，通过灌注成像评估，心绞痛和心力衰竭症状有短期改善，缺血评分适度降低。结论我们的 1 期临床研究检查了慢性 ICM 且无血运重建方案的患者中靶向经心肌激光血运重建疗法和自体 CD133 + 内皮祖细胞的联合治疗，证明了这种联合方法的可行性和短期安全性，并保证了未来更大规模的 2 期随机临床研究研究。
ObjectiveWe tested the hypothesis that targeted TMLR combined with intramyocardial injection of autologous CD 133+progenitor cells is safe and feasible in patients with chronic ischemic cardiomyopathy (ICM) and no revascularization options.MethodsEight male patients (age 62 ± 2.4 years) with multivessel severe ischemic heart disease and no revascularization options were enrolled. Autologous CD 133 + endothelial progenitor cells were derived and purified from the bone marrow on the day of surgery using the clinical-grade closed CliniMACS system. Using a lateral thoracotomy approach, TMLR was performed, followed by transmyocardial transplantation of purified CD133 + cells (mean number of transplanted cells: 12.5 × 106) in the region surrounding the TMLR sites. These sites were selected based on ischemia on pre-procedure perfusion imaging. We performed clinical and myocardial perfusion imaging pre-procedure and then at 6- and 12-month follow-up.ResultsNo major complications or death occurred during the procedure or during the peri-operative hospital stay. One patient died of cardiac cause 6 months post-procedure. There was a reported short-term improvement in anginal and heart failure symptoms and a modest reduction in the ischemic score as assessed by perfusion imaging.ConclusionsOur phase 1 clinical study examining the combination therapy of targeted transmyocardial laser revascularization therapy and autologous CD133 + endothelial progenitor cells in patients with chronic ICM and no revascularization options demonstrates the feasibility and short-term safety of this combined approach and warrants future larger phase 2 randomized clinical studies.