Improved exercise capacity and ischemia 6 and 12 months after transendocardial injection of autologous bone marrow mononuclear cells for ischemic cardiomyopathy.
BACKGROUND
We recently reported the safety and feasibility of autologous bone marrow mononuclear cell (ABMMNC) injection into areas of ischemic myocardium in patients with end-stage ischemic cardiomyopathy. The present study evaluated the safety and efficacy of this therapy at 6- and 12-month follow-up.


RESULTS
Twenty patients with 6- and 12-month follow-up (11 treated subjects; 9 controls) were enrolled in this prospective, nonrandomized, open-label study. Complete clinical and laboratory evaluations as well as exercise stress (ramp treadmill), 2-dimensional Doppler echocardiography, single-photon emission computed tomography (SPECT) perfusion scanning, and 24-hour Holter monitoring were performed at baseline and follow-up. Transendocardial delivery of ABMMNCs was performed with the aid of electromechanical mapping to identify viable myocardium. Each patient received 15 ABMMNC injections of 0.2 mL each. At 6 and 12 months, total reversible defect, as measured by SPECT perfusion scanning, was significantly reduced in the treatment group as compared with the control group. At 12 months, exercise capacity was significantly improved in the treatment group. This improvement correlated well with monocyte, B-cell, hematopoietic progenitor cell, and early hemapoietic progenitor cell phenotypes.


CONCLUSIONS
The 6- and 12-month follow-up data in this study suggest that transendocardial injection of ABMMNCs in patients with end-stage ischemic heart disease may produce a durable therapeutic effect and improve myocardial perfusion and exercise capacity.
Perin
Emerson C
EC
Texas Heart Institute at St. Luke's Episcopal Hospital, .), Houston, Tex, USA. eperin@crescentb.net
Dohmann
Hans F R
HF
Borojevic
Radovan
R
Silva
Suzana A
SA
Sousa
Andre L S
AL
Silva
Guilherme V
GV
Mesquita
Claudio T
CT
Belém
Luciano
L
Vaughn
William K
WK
Rangel
Fernando O D
FO
Assad
Joao A R
JA
Carvalho
Antonio C
AC
Branco
Rodrigo V C
RV
Rossi
Maria I D
MI
Dohmann
Hans J F
HJ
Willerson
James T
JT
D000368:Aged; D001402:B-Lymphocytes / Q000166:cytology; D001854:Bone Marrow Cells / Q000145:classification; D002454:Cell Differentiation; D019070:Cell Lineage; D015150:Echocardiography, Doppler; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000166:cytology; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000628:therapy*; D010101:Oxygen Consumption; D011446:Prospective Studies; D012008:Recurrence; D015899:Tomography, Emission-Computed, Single-Photon; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000628:therapy