NEW YORK (Reuters Health) - Stem cell transplantation into ischemic myocardium seems to be safe and feasible, according to results of a phase I trial conducted in Italy. As physicians in report in the November issue of the Annals of Thoracic Surgery, this technique may help regenerate tissue in ischemic regions that cannot be revascularized by conventional means.
Dr. Giulio Pompilio, at Centro Cardiologico Monzino IRCCS in Milan, and associates developed a new technique for isolating autologous stem cells, in which the hematopoietic growth factor Lenograstim (Aventis Pharma) was administered subcutaneously to four patients for 4 consecutive days to mobilize stem cells from the bone marrow to the peripheral blood.
Peripheral blood derived stem cells were collected by apheresis and purified to isolate the CD133+ fraction. The patients who received the autologous grafts had experienced an MI at least 10 days earlier or had large ischemic areas in the left ventricle not amenable to traditional treatment.
Stem cells were injected into target areas of beating hearts of three patients as they underwent off-pump coronary artery bypass grafting (CABG). A fourth patient who had undergone CABG 6 years earlier was treated with PBSC implant through a transdiaphragmatic approach.
“In an attempt to induce myocardial repair, injections were accomplished along the border of the myocardial scar, directly visualized on the beating heart,” the authors note.
Alternatively, cells were injected into chronically ischemic ungraftable myocardium, identified by scintigraphy and echocardiography prior to the procedure, to induce angiogenesis.
Cell mobilization and apheresis were well tolerated, Dr. Pompilio’s group reports. The only postoperative complication was atrial fibrillation in one patient, which was successfully treated pharmacologically. There were no complications evident 4 months after the procedure.
Two patients completed 6-month follow-up. “Improvement in perfusion of an ischemic ungrafted area and recovery of viability of a recent infarction were observed,” the authors add.
“Cell transplantation may become routine during CABG for patients who cannot be adequately revascularized,” Dr. Shafie Fazel and colleagues at Toronto General Hospital write in an accompanying commentary. They suggest that further studies should clarify which cells to use, and whether they are fresh or expanded in vitro or through gene-enhancement.
Source: Ann Thorac Surg 2004;78:1808-1813. [ Google search on this article ]
MeSH Headings:Clinical Trials: Environment and Public Health: Epidemiologic Methods: Evaluation Studies: Health: Health Occupations: Health Services Administration: Medicine: Investigative Techniques: Population Characteristics: Preventive Medicine: Public Health: Quality of Health Care: Specialties, Medical: Transplantation, Autologous: Epidemiologic Study Characteristics: Hematopoietic Cell Growth Factors: Clinical Trials, Phase I: Health Care Quality, Access, and Evaluation: Health Care Evaluation Mechanisms: Analytical, Diagnostic and Therapeutic Techniques and Equipment: Biological Sciences: Health CareCopyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
