[Diabetic and nondiabetic patients respond differently to transendocardial injection of bone marrow mononuclear cells: findings from prospective clinical trials in "no-option" patients].
Whether stem cell treatment has the same effect in diabetics and nondiabetics is unknown. To compare outcomes in these two groups, we analyzed data from 26 consecutive patients with chronic ischemic cardiomyopathy who were taking part in two clinical trials. Revascularization was not an option for these patients and they were treated with bone marrow mononuclear cells (BMMNCs). Patients underwent NOGA electromechanical mapping to identify viable myocardium (i.e., with a unipolar voltage > or = 6.9 mV), after which they received a mean of 28.5+/-4.7 x 10(6) BMMNCs. Patients were followed up at 6 months. In nondiabetics, there was a significant decrease in endsystolic volume between baseline and 6-month follow-up. In addition, New York Heart Association (NYHA) functional class decreased significantly (P=.04) from 3.0 (1.75-3.0) to 1.0 (1.0-2.0), the Canadian Cardiovascular Society angina score (CCSAS) improved significantly (P=.04) from 3.0 (2.0-4.0) to 1.0 (1.0-1.5), and oxygen uptake increased significantly (P=.04) from 16.4 (13.1-21.5) to 24.5 (17.3-29.2) ml/kg/min. These changes were not observed in diabetic patients. This is the first clinical study to show that BMMNC injection could have a smaller effect in diabetics.
Centro de Terapia Celular, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas, Estados Unidos.
Pilar
P
Jiménez-Quevedo
Guillherme V
GV
Silva
Ricardo
R
Sanz-Ruiz
Edie M
EM
Oliveira
Marlos R
MR
Fernandes
Franca
F
Angeli
James T
JT
Willerson
Hans F
HF
Dohmann
Emerson C
EC
Perin
D000368:Aged; D016026:Bone Marrow Transplantation / Q000379:methods; D003327:Coronary Disease / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000628:therapy*; D004699:Endocardium; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D011446:Prospective Studies