Intracoronary transplantation of non-expanded peripheral blood-derived mononuclear cells promotes improvement of cardiac function in patients with acute myocardial infarction
Intracoronary transplantation of non-expanded peripheral blood-derived mononuclear cells promotes improvement of cardiac function in patients with acute myocardial infarction
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DOI：
10.1253/circj.71.1199
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发表时间：
2007-08-01
影响因子：
3.3
通讯作者：
Matsubara, Hiroaki
中科院分区：
文献类型：
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作者：
Tatsumi, Tetsuya;Ashihara, Eishi;Matsubara, Hiroaki
背景非扩增外周血单个核细胞（PBMNCs）移植通过释放血管生成因子促进缺血心肌和肢体的新生血管形成。本研究旨在探讨外周血单个核细胞冠状动脉内移植是否改善急性心肌梗死（AMI）后的心功能。方法和结果ST段抬高的急性心肌梗死（AMI）伴冠状动脉左前降支近端闭塞24小时内经皮冠状动脉介入治疗（PCI）成功后，患者被分配到对照组或在PCT后5天内接受PBMNC冠状动脉内输注的PBMNC组。采用COBE单采法采集患者外周血单个核细胞，浓缩至10 ml，其中3.3ml经整体导管输注。主要终点是总体左心室射血分数（LVEF）从基线到6个月随访的变化。数据显示，对照组和PBMNC组的LVEF绝对增加分别为7.4%和13.4%（p=0.037 vs对照）。与对照组相比，细胞治疗导致A区域射血分数（EF）或室壁运动评分指数和与梗死面积相关的Tc-99 m-tetrofosmin灌注缺损评分的显著改善的趋势更大。此外，冠状动脉内输注PBMNCs没有加重左心室（LV）舒张末期和收缩末期容积扩张或高危心律失常，没有任何不良临床事件。结论冠状动脉内输注非扩张PBMNCs促进左心室收缩功能的改善。这种侵入性更小、更可行的收集内皮祖细胞的方法可能为改善AMT后的心功能提供一种新的治疗选择。
Background Transplantation of non-expanded peripheral blood mononuclear cells (PBMNCs) enhances neovessel formation in ischemic myocardium and limbs by releasing angiogenic factors. This study was designed to examine whether intracoronary transplantation of PBMNCs improves cardiac function after acute myocardial infarction (AMI).Methods and Results After successful percutaneous coronary intervention (PCI) for a ST-elevation AMI with occlusion of proximal left anterior descending coronary artery within 24h, patients were assigned to either a control group or the PBMNC group that received intracoronary infusion of PBMNCs within 5 days after PCT. PBMNCs were obtained from patients by COBE spectra-apheresis and concentrated to 10ml, 3.3ml of which was infused via over-the-wire catheter. The primary endpoint was the global left ventricular ejection fraction (LVEF) change from baseline to 6 months' follow-up. The data showed that the absolute increase in LVEF was 7.4% in the control group and 13.4% (p=0.037 vs control) in the PBMNC group. Cell therapy resulted in a greater tendency of ARegional ejection fraction (EF) or significant improvement in the wall motion score index and Tc-99m-tetrofosmin perfusion defect score associated with the infarct area, compared with controls. Moreover, intracoronary administration of PBMNCs did not exacerbate either left ventricular (LV) end-diastolic and endsystolic volume expansion or high-risk arrhythmia, without any adverse clinical events.Conclusion Intracoronary infusion of non-expanded PBMNCs promotes improvement of LV systolic function. This less invasive and more feasible approach to collecting endothelial progenitor cells may provide a novel therapeutic option for improving cardiac function after AMT.