Transcoronary transplantation of progenitor cells after myocardial infarction.
BACKGROUND
Pilot studies suggest that intracoronary transplantation of progenitor cells derived from bone marrow (BMC) or circulating blood (CPC) may improve left ventricular function after acute myocardial infarction. The effects of cell transplantation in patients with healed myocardial infarction are unknown.


METHODS
After an initial pilot trial involving 17 patients, we randomly assigned, in a controlled crossover study, 75 patients with stable ischemic heart disease who had had a myocardial infarction at least 3 months previously to receive either no cell infusion (23 patients) or infusion of CPC (24 patients) or BMC (28 patients) into the patent coronary artery supplying the most dyskinetic left ventricular area. The patients in the control group were subsequently randomly assigned to receive CPC or BMC, and the patients who initially received BMC or CPC crossed over to receive CPC or BMC, respectively, at 3 months' follow-up.


RESULTS
The absolute change in left ventricular ejection fraction was significantly greater among patients receiving BMC (+2.9 percentage points) than among those receiving CPC (-0.4 percentage point, P=0.003) or no infusion (-1.2 percentage points, P<0.001). The increase in global cardiac function was related to significantly enhanced regional contractility in the area targeted by intracoronary infusion of BMC. The crossover phase of the study revealed that intracoronary infusion of BMC was associated with a significant increase in global and regional left ventricular function, regardless of whether patients crossed over from control to BMC or from CPC to BMC.


CONCLUSIONS
Intracoronary infusion of progenitor cells is safe and feasible in patients with healed myocardial infarction. Transplantation of BMC is associated with moderate but significant improvement in the left ventricular ejection fraction after 3 months.
Assmus
Birgit
B
Division of Cardiology and Molecular Cardiology, Department of Medicine III, Johann Wolfgang Goethe University, Frankfurt, Germany.
Honold
Jörg
J
Schächinger
Volker
V
Britten
Martina B
MB
Fischer-Rasokat
Ulrich
U
Lehmann
Ralf
R
Teupe
Claudius
C
Pistorius
Katrin
K
Martin
Hans
H
Abolmaali
Nasreddin D
ND
Tonn
Torsten
T
Dimmeler
Stefanie
S
Zeiher
Andreas M
AM
D000368:Aged; D016026:Bone Marrow Transplantation / Q000379:methods; D017023:Coronary Angiography; D003331:Coronary Vessels; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D033581:Stem Cell Transplantation / Q000379:methods; D013318:Stroke Volume; D014182:Transplantation, Autologous; D016277:Ventricular Function, Left