title: Catheter-based intramyocardial injection of autologous skeletal myoblasts as a primary treatment of ischemic heart failure: clinical experience with six-month follow-up.
abstract: OBJECTIVE
  We report on the procedural and six-month results of the first percutaneous and stand-alone study on myocardial repair with autologous skeletal myoblasts.
  
  
  BACKGROUND
  Preclinical studies have shown that skeletal myoblast transplantation to injured myocardium can partially restore left ventricular (LV) function.
  
  
  METHODS
  In a pilot safety and feasibility study of five patients with symptomatic heart failure (HF) after an anterior wall infarction, autologous skeletal myoblasts were obtained from the quadriceps muscle and cultured in vitro for cell expansion. After a culturing process, 296 +/- 199 million cells were harvested (positive desmin staining 55 +/- 30%). With a NOGA-guided catheter system (Biosense-Webster, Waterloo, Belgium), 196 +/- 105 million cells were transendocardially injected into the infarcted area. Electrocardiographic and LV function assessment was done by Holter monitoring, LV angiography, nuclear radiography, dobutamine stress echocardiography, and magnetic resonance imaging (MRI).
  
  
  RESULTS
  All cell transplantation procedures were uneventful, and no serious adverse events occurred during follow-up. One patient received an implantable cardioverter-defibrillator after transplantation because of asymptomatic runs of nonsustained ventricular tachycardia. Compared with baseline, the LV ejection fraction increased from 36 +/- 11% to 41 +/- 9% (3 months, p = 0.009) and 45 +/- 8% (6 months, p = 0.23). Regional wall analysis by MRI showed significantly increased wall thickening at the target areas and less wall thickening in remote areas (wall thickening at target areas vs. 3 months follow-up: 0.9 +/- 2.3 mm vs. 1.8 +/- 2.4 mm, p = 0.008).
  
  
  CONCLUSIONS
  This pilot study is the first to demonstrate the potential and feasibility of percutaneous skeletal myoblast delivery as a stand-alone procedure for myocardial repair in patients with post-infarction HF. More data are needed to confirm its safety.
authors.affiliation: Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands. p.c.smits@erasmusmc.nl
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Smits
authors.forename: Robert-Jan M
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
authors.forename: Manolis
authors.initials: M
authors.lastname: Bountioukos
authors.forename: Emile E M
authors.initials: EE
authors.lastname: Onderwater
authors.forename: Chi Hang
authors.initials: CH
authors.lastname: Lee
authors.forename: Alex P W M
authors.initials: AP
authors.lastname: Maat
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D001706:Biopsy; D006328:Cardiac Catheterization; D002478:Cells, Cultured; D004452:Echocardiography; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007267:Injections; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D032448:Myoblasts, Skeletal / Q000637:transplantation*; D009203:Myocardial Infarction / Q000150:complications*; D010865:Pilot Projects; D012449:Safety; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D014182:Transplantation, Autologous; D016277:Ventricular Function, Left / Q000502:physiology*