Intramyocardial stem cell injection in patients with ischemic cardiomyopathy: functional recovery and reverse remodeling.
Intramyocardial stem cell injection in patients with ischemic cardiomyopathy: functional recovery and reverse remodeling.
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DOI：
10.1161/circresaha.111.242610
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发表时间：
2011-04-01
影响因子：
20.1
通讯作者：
Hare JM
中科院分区：
文献类型：
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作者：
Williams AR;Trachtenberg B;Velazquez DL;McNiece I;Altman P;Rouy D;Mendizabal AM;Pattany PM;Lopera GA;Fishman J;Zambrano JP;Heldman AW;Hare JM
经导管，心肌内注射骨髓源性细胞治疗在缺血性心肌病的大型动物模型中产生逆向重塑。我们对远端心肌梗死（MI）相关左室功能障碍患者进行心脏磁共振成像（CMR），验证骨髓祖细胞注射导致瘢痕心肌功能恢复和逆转重构的假设。8例患者（年龄57.2±13.3岁）在左室瘢痕及边缘区接受经心内膜、心内注射自体骨髓祖细胞（单核或间充质干细胞）。所有患者均耐受该手术，无严重不良事件。1年CMR显示舒张末期体积减小（208.7±20.4 vs. 167.4±7.32mL, p=0.03），收缩末期体积减小（142.4±16.5 vs. 107.6±7.4mL, p=0.06），梗死面积减小（p<0.05），梗死区Ecc峰值改善局部左室功能（-8.1±1.0 vs. -11.4±1.3,p=0.04）。区域功能的改善在3个月时很明显，而腔室尺寸的变化直到6个月才显着。梗死区区域功能的改善与EDV （r2=0.69, p=0.04）和ESV （r2=0.83, p=0.01）的降低密切相关。这些数据表明，经导管、心内注射自体骨髓祖细胞可改善慢性心肌瘢痕的局部收缩性，这些变化可预测随后的反向重构。研究结果支持这种新的治疗策略和正在进行的随机临床试验的潜在临床益处。
Transcatheter, intramyocardial injections of bone marrow derived cell therapy produces reverse remodeling in large animal models of ischemic cardiomyopathy. We used cardiac magnetic resonance imaging (CMR) in patients with LV dysfunction related to remote myocardial infarction (MI) to test the hypothesis that bone marrow progenitor cell injection cause functional recovery of scarred myocardium and reverse remodeling. Eight patients (age 57.2±13.3) received transendocardial, intramyocardial injection of autologous bone marrow progenitor cells (mononuclear or mesenchymal stem cells) in LV scar and border zone. All patients tolerated the procedure with no serious adverse events. CMR at 1-year demonstrated a decrease in end-diastolic volume (208.7±20.4 vs. 167.4±7.32mL; p=0.03), a trend towards decreased end-systolic volume (142.4±16.5 vs. 107.6±7.4mL; p=0.06), decreased infarct size (p<0.05), and improved regional LV function by peak Ecc in the treated infarct zone (-8.1±1.0 vs. -11.4±1.3; p=0.04). Improvements in regional function were evident at 3 months, while the changes in chamber dimensions were not significant until 6 months. Improved regional function in the infarct zone strongly correlated with reduction of EDV (r2=0.69, p=0.04) and ESV (r2=0.83, p=0.01). These data suggest that transcatheter, intramyocardial injections of autologous bone marrow progenitor cells improve regional contractility of a chronic myocardial scar and these changes predict subsequent reverse remodeling. The findings support the potential clinical benefits of this new treatment strategy and ongoing randomized clinical trials.