Intramyocardial and intracoronary autologous bone marrow-derived mesenchymal stromal cell treatment in chronic severe dilated cardiomyopathy
Intramyocardial and intracoronary autologous bone marrow-derived mesenchymal stromal cell treatment in chronic severe dilated cardiomyopathy
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DOI：
10.3109/14653249.2011.574118
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发表时间：
2011-01-01
期刊：
影响因子：
4.5
通讯作者：
Cheong, Soon-Keng
中科院分区：
文献类型：
--
作者：
Chin, Sze-Piaw;Poey, Alfred C.;Cheong, Soon-Keng
背景目标。间充质基质细胞（MSC）可以改善心肌梗死后的心功能。MSC可以分化为心肌细胞和内皮细胞，同时发挥额外的旁分泌作用。关于MSC治疗重度扩张型心肌病（DCM）的有效性的信息有限。本研究的目的是证明直接心肌内和冠状动脉内给予自体骨髓来源的MSC治疗慢性重度难治性DCM患者的临床安全性，可行性和有效性。方法.选择了10名有症状的DCM和难治性心功能患者，尽管进行了最大限度的药物治疗。5名患有缺血性DCM的患者被认为不太可能从单独的血运重建中获益，并接受了旁路手术和同时心肌内MSC注射（A组）。2例患者既往接受过血运重建，3例患有非缺血性DCM并接受冠状动脉内MSC注射（B组）。结果A组和B组患者分别接受0.5-1.0 × 10（6）和2.0-3.0 × 10（6）MSC/kg体重。所有患者均存活1年。从基线到6个月和12个月，左心室射血分数和其他左心室参数有显著改善。6例患者在12个月时观察到瘢痕减少。结论.自体骨髓间充质干细胞治疗是安全和可行的，有效地治疗慢性严重难治性DCM，通过冠状动脉内或直接心肌内管理在规定的剂量。
Background aims. Mesenchymal stromal cells (MSC) may improve cardiac function following myocardial infarction. MSC can differentiate into cardiomyocytes and endothelial cells while exerting additional paracrine effects. There is limited information regarding the efficacy of route for MSC treatment of severe dilated cardiomyopathy (DCM). The aim of this study was to demonstrate the clinical safety, feasibility and efficacy of direct intramyocardial and intracoronary administration of autologous bone marrow-derived MSC treatment for no-option patients with chronic severe refractory DCM. Methods. Ten symptomatic patients with DCM and refractory cardiac function, despite maximum medical therapy, were selected. Five had ischemic DCM deemed unlikely to benefit from revascularization alone and underwent bypass operations with concurrent intramyocardial MSC injection (group A). Two patients had previous revascularization and three had non-ischemic DCM and received intracoronary MSC injection (group B). Results. Group A and B patients received 0.5-1.0 x 10(6) and 2.0-3.0 X 10(6) MSC/kg body weight, respectively. All patients remained alive at 1 year. There were significant improvements from baseline to 6 and 12 months in left ventricular ejection fraction and other left ventricular parameters. Scar reduction was noted in six patients by 12 months. Conclusions. Autologous bone marrow MSC treatment is safe and feasible for treating chronic severe refractory DCM effectively, via intracoronary or direct intramyocardial administration at prescribed doses.