A critical challenge: Dosage-related efficacy and acute complication intracoronary injection of autologous bone marrow mesenchymal stem cells in acute myocardial infarction
A critical challenge: Dosage-related efficacy and acute complication intracoronary injection of autologous bone marrow mesenchymal stem cells in acute myocardial infarction
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DOI：
10.1016/j.ijcard.2013.04.112
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发表时间：
2013-10-09
影响因子：
3.5
通讯作者：
Yang, Ye
中科院分区：
文献类型：
--
作者：
Gao, Lian R.;Pei, Xue T.;Yang, Ye
背景：先前的研究表明，AMI 后注射骨髓间充质干细胞 (BMSC) 可改善心脏功能。新的证据表明，骨髓间充质干细胞的数量和功能都会随着衰老而下降。我们设计了一项随机对照试验来进一步探讨该治疗的安全性和有效性。方法：12小时内成功再灌注治疗的ST段抬高型AMI患者被随机分配接受BMSCs冠状动脉输注（n = 21）或标准药物治疗（n = 22）（由于冠状动脉阻塞并发症，患者数量有限）。 BMSC 的数量和功能与基线时 (r = 0.679，P = 0.001) 和 12 个月随访时 (r = 0.477，P = 0.039) 反映的心功能。细胞给药后六个月，18-FDG SPECT 测定的梗塞区域心肌活力与基线相比，两组均有所改善，但 BMSC 与对照组相比无显着差异（4.0 +/- 0.4% 95% CI 3.1-4.9 vs. 3.2 +/- 0.5% 95% CI 2.1-4.3，P = 0.237）。 99mTc-sestamibi SPECT 证明 BMSC 梗塞区域内的心肌灌注与对照组没有差异（4.4 +/- 0.5% 95% CI 3.2-5.5 vs. 3.9 +/- 0.6% 95% CI 2.6-5.2，P = 0.594）。同样，随访 12 个月和 24 个月后，两组之间的 LVEF 也没有显示出任何差异。 BMSCs组中，有1例患者在BMSCs注射过程中出现严重的冠状动脉闭塞并发症。结论：急性STEMI患者冠状动脉内注射自体BMSCs的临床获益需要进一步研究和重新评估。 (C) 2013 Elsevier Ireland Ltd. 保留所有权利。
Background: Previous studies showed improvement in heart function by injecting bone marrow mesenchymal stem cells (BMSCs) after AMI. Emerging evidence suggested that both the number and function of BMSCs decline with ageing. We designed a randomized, controlled trial to further investigate the safety and efficacy of this treatment.Methods: Patients with ST-elevation AMI undergoing successful reperfusion treatment within 12 hours were randomly assigned to receive an intracoronary infusion of BMSCs (n = 21) or standard medical treatment (n = 22) (the numbers of patients were limited because of the complication of coronary artery obstruction).Results: There is a closely positive correlation of the number and function of BMSCs vs. the cardiac function reflected by LVEF at baseline (r = 0.679, P = 0.001) and at 12-month follow-up (r = 0.477, P = 0.039). Six months after cell administration, myocardial viability within the infarct area by 18-FDG SPECT was improved in both groups compared with baseline, but no significant difference in the BMSCs compared with control groups (4.0 +/- 0.4% 95%CI 3.1-4.9 vs. 3.2 +/- 0.5% 95%CI 2.1-4.3, P = 0.237). 99mTc-sestamibi SPECT demonstrated that myocardial perfusion within the infarct area in the BMSCs did not differ from the control group (4.4 +/- 0.5% 95%CI 3.2-5.5 vs. 3.9 +/- 0.6% 95%CI 2.6-5.2, P = 0.594). Similarly, LVEF after 12 and 24 months follow-up did not show any difference between the two groups. In the BMSCs group, one patient suffered a serious complication of coronary artery occlusion during the BMSCs injection procedure.Conclusions: The clinical benefits of intracoronary injection of autologous BMSCs in acute STEMI patients need further investigation and reevaluation. (C) 2013 Elsevier Ireland Ltd. All rights reserved.