title: Direct minimally invasive intramyocardial injection of bone marrow-derived AC133+ stem cells in patients with refractory ischemia: preliminary results.
abstract: BACKGROUND
  Bone marrow-derived stem cells (BMSC) may represent a viable option for patients with myocardial ischemia refractory to conventional treatments.
  
  
  METHODS
  In 5 patients (4 males and 1 female, mean age 64 +/- 8 years) with untreatable angina pectoris (Canadian Cardiovascular Society Class III/IV), myocardial segments with stress-induced ischemia as assessed by gated single-photon emission computed tomography were injected with 4 to 12 million CD133+ BMSC. Cells were injected into the myocardium (2 anterior, 2 lateral, 1 inferior wall) through minimally invasive approaches (left minithoracotomy [n = 4] and subdiaphragmatic approach [n = 1]). At baseline, at 6 months and at 1 year of follow-up, an exercise test, gated single-photon emission computed tomography (SPECT), 2-D echocardiography and coronary angiography were performed to assess exercise capacity, myocardial perfusion, LV function and coronary anatomy.
  
  
  RESULTS
  Intramyocardial injection of autologous CD133+ BMSC cells was safe. No early or long-term complications were observed. After an average of 3.8 weeks from cell inoculation, all patients experienced a significant improvement of CCS class (from 3.8 to 1.8 at 6 months) and serial SPECT documented improvements of rest and stress perfusion in the injected territories at 6 months from operation. In 3 cases, coronary angiography showed an increase in the collateral score of the target areas. Clinical improvements still persist unchanged in 4 out of 5 cases at a mean of 36.5 months postoperatively.
  
  
  CONCLUSIONS
  After stand-alone BMSC transplantation for refractory myocardial ischemia, we observed long-term clinical and perfusion improvements in the absence of adverse events.
authors.affiliation: Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy. giulio.pompilio@ccfm.it
authors.forename: G
authors.initials: G
authors.lastname: Pompilio
authors.forename: G
authors.initials: G
authors.lastname: Steinhoff
authors.forename: A
authors.initials: A
authors.lastname: Liebold
authors.forename: M
authors.initials: M
authors.lastname: Pesce
authors.forename: F
authors.initials: F
authors.lastname: Alamanni
authors.forename: M C
authors.initials: MC
authors.lastname: Capogrossi
authors.forename: P
authors.initials: P
authors.lastname: Biglioli
mesh_terms: D000071916:AC133 Antigen; D000368:Aged; D000787:Angina Pectoris / Q000628:therapy*; D015703:Antigens, CD; D005260:Female; D006023:Glycoproteins; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D007267:Injections; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D008875:Middle Aged; D017202:Myocardial Ischemia; D018919:Neovascularization, Physiologic; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D010455:Peptides; D010865:Pilot Projects; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon; D014182:Transplantation, Autologous
chemical_list: D000071916:AC133 Antigen; D015703:Antigens, CD; D006023:Glycoproteins; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; C000606023:PROM1 protein, human; D010455:Peptides; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin