Intramyocardial transplantation of autologous CD34+ stem cells for intractable angina: a phase I/IIa double-blind, randomized controlled trial.
BACKGROUND
A growing population of patients with coronary artery disease experiences angina that is not amenable to revascularization and is refractory to medical therapy. Preclinical studies have indicated that human CD34+ stem cells induce neovascularization in ischemic myocardium, which enhances perfusion and function.


RESULTS
Twenty-four patients (19 men and 5 women aged 48 to 84 years) with Canadian Cardiovascular Society class 3 or 4 angina who were undergoing optimal medical treatment and who were not candidates for mechanical revascularization were enrolled in a double-blind, randomized (3:1), placebo-controlled dose-escalating study. Patients received granulocyte colony-stimulating factor 5 microg x kg(-1) x d(-1) for 5 days with leukapheresis on the fifth day. Selection of CD34+ cells was performed with a Food and Drug Administration-approved device. Electromechanical mapping was performed to identify ischemic but viable regions of myocardium for injection of cells (versus saline). The total dose of cells was distributed in 10 intramyocardial, transendocardial injections. Patients were required to have an implantable cardioverter-defibrillator or to temporarily wear a LifeVest wearable defibrillator. No incidence was observed of myocardial infarction induced by mobilization or intramyocardial injection. The intramyocardial injection of cells or saline did not result in cardiac enzyme elevation, perforation, or pericardial effusion. No incidence of ventricular tachycardia or ventricular fibrillation occurred during the administration of granulocyte colony-stimulating factor or intramyocardial injections. One patient with a history of sudden cardiac death/ventricular tachycardia/ventricular fibrillation had catheter-induced ventricular tachycardia during mapping that required cardioversion. Serious adverse events were evenly distributed. Efficacy parameters including angina frequency, nitroglycerine usage, exercise time, and Canadian Cardiovascular Society class showed trends that favored CD34+ cell-treated patients versus control subjects given placebo.


CONCLUSIONS
A randomized trial of intramyocardial injection of autologous CD34+ cells in patients with intractable angina was completed that provides evidence for feasibility, safety, and bioactivity. A larger phase IIb study is currently under way to further evaluate this therapy.
Losordo
Douglas W
DW
Feinberg Cardiovascular Research Institute, and Department of Medicine, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, IL 60611, USA. d-losordo@northwestern.edu
Schatz
Richard A
RA
White
Christopher J
CJ
Udelson
James E
JE
Veereshwarayya
Vimal
V
Durgin
Michelle
M
Poh
Kian Keong
KK
Weinstein
Robert
R
Kearney
Marianne
M
Chaudhry
Muqtada
M
Burg
Aaron
A
Eaton
Liz
L
Heyd
Lindsay
L
Thorne
Tina
T
Shturman
Leon
L
Hoffmeister
Peter
P
Story
Ken
K
Zak
Victor
V
Dowling
Douglas
D
Traverse
Jay H
JH
Olson
Rachel E
RE
Flanagan
Janice
J
Sodano
Donata
D
Murayama
Toshinori
T
Kawamoto
Atsuhiko
A
Kusano
Kengo Fukushima
KF
Wollins
Jill
J
Welt
Frederick
F
Shah
Pinak
P
Soukas
Peter
P
Asahara
Takayuki
T
Henry
Timothy D
TD
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002452:Cell Count; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004554:Electric Countershock; D015716:Electrocardiography, Ambulatory; D017079:Exercise Tolerance; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods; D011788:Quality of Life; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D016179:Granulocyte Colony-Stimulating Factor