Myocardial Cellular Stimulation of Angiogenesis

刺激心肌血管生成可能是减轻缺血、提高患者生活质量的重要手段。心肌激光血管重建术（TMR）就是这样一种方法，它利用高功率激光来创造一个可控的损伤，并产生自然的血管生成反应。虽然两种不同波长的激光的临床结果据报道是相似的，但激光组织相互作用之间存在巨大差异。我们研究了这种差异是否导致心肌功能改变，以及每种激光达到临床成功的机制是否不同。

The stimulation of myocardial angiogenesis may be an important method to diminsh ischemia and improve the quality of patients' lives. Transmyocardial laser revascularization (TMR)is one such method that employs the use of a high powered laser to create a controlled injury and engender the natural angiogenic response. While clinical results with two different wavelengths of laser light are reportedly similar there are vast differences between the laser tissue interactions. We investigated whether this difference led to a myocardial functional change and whether the mechanisms whereby each laser achieves its clinical success is different. Employing a porcine model of chronic myocardial ischemia; cine MRI, hyperenhancement MRI, rest and stress echocardiography and histology were performed after TMR. There were significant improvements in myocardial function after treatment by a carbon dioxide that were not seen when a holmium:YAG device was used. Histology and MRI confirmed more scarrring and less angiogenesis with the Ho:YAG device at 6 weeks post treatment. Building on these results we have embarked on the addition of cellular therapy to further enhance the angiogenic response engendered by the laser. Using autologous bone marrow which has been allowed to differentiate and expand, mesenchymal stem cells are injected into the ischemic zone of the aforementioned large animal model. MRI, echo and histologic endpoints are being gathered to determine if a synergistic response is possible.