Autologous bone-marrow mononuclear cell transplantation after acute myocardial infarction: comparison of two delivery techniques.
The objective of this study was to investigate safety and feasibility of autologous bone marrow mononuclear cells (BMMNC) transplantation in ST elevation myocardial infarction (STEMI), comparing anterograde intracoronary artery (ICA) delivery with retrograde intracoronary vein (ICV) approach. An open labeled, randomized controlled trial of 30 patients admitted with STEMI was used. Patients were enrolled if they 1) were successfully reperfused within 24 h from symptoms onset and 2) had infarct size larger than 10% of the left ventricle (LV). One hundred million BMMNC were injected in the infarct-related artery (intra-arterial group) or vein (intravenous group), 1% of which was labeled with Tc(99m)-hexamethylpropylenamineoxime. Cell distribution was evaluated 4 and 24 h after injection. Baseline MRI was performed in order to evaluate microbstruction pattern. Baseline radionuclide ventriculography was performed before cell transfer and after 3 and 6 months. All the treated patients were submitted to repeat coronary angiography after 3 months. Thirty patients (57 +/- 11 years, 70% males) were randomly assigned to ICA (n = 14), ICV (n = 10), or control (n = 6) groups. No serious adverse events related to the procedure were observed. Early and late retention of radiolabeled cells was higher in the ICA than in the ICV group, independently of microcirculation obstruction. An increase of EF was observed in the ICA group (p = 0.02) compared to baseline. Injection procedures through anterograde and retrograde approaches seem to be feasible and safe. BMMNC retention by damaged heart tissue was apparently higher when the anterograde approach was used. Further studies are required to confirm these initial data.
Silva
Suzana A
SA
Teaching and Research Center of Pró-Cardíaco/PROCEP, Rio de Janeiro, Brazil.
Sousa
André L S
AL
Haddad
Andrea F
AF
Azevedo
Jader C
JC
Soares
Vinicio E
VE
Peixoto
Cíntia M
CM
Soares
Ana J S
AJ
Issa
Aurora F C
AF
Felipe
Luis Renato V
LR
Branco
Rodrigo V C
RV
Addad
João A
JA
Moreira
Rodrigo C
RC
Tuche
Fabio A A
FA
Mesquita
Cláudio T
CT
Drumond
Cristina C O
CC
Junior
Amarino O
AO
Rochitte
Carlos E
CE
Luz
José H M
JH
Rabischoffisky
Arnaldo
A
Nogueira
Fernanda B
FB
Vieira
Rosana B C
RB
Junior
Hamilton S
HS
Borojevic
Radovan
R
Dohmann
Hans F R
HF
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016026:Bone Marrow Transplantation / Q000379:methods*; D003710:Demography; D005260:Female; D006801:Humans; D007267:Injections; D007963:Leukocytes, Mononuclear / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D009566:Nitrates; D015635:Radionuclide Ventriculography; D019690:Technetium Tc 99m Exametazime; D017256:Technetium Tc 99m Sestamibi; D014182:Transplantation, Autologous
D009566:Nitrates; D019690:Technetium Tc 99m Exametazime; D017256:Technetium Tc 99m Sestamibi