Intracoronary blood- or bone marrow-derived cell transplantation in patients with ischemic heart disease.
Soon after the first experimental scientific investigations of cell transplantation in various animal models of myocardial infarction and left ventricular dysfunction, a growing number of clinical trials evaluated the effects of intracoronary injection of peripheral blood- or bone marrow-derived cells in patients with myocardial infarction or chronic ischemic heart disease. In most of these trials, changes in parameters of left ventricular remodeling over time, such as left ventricular volumes, ejection fraction or infarct size, were used as trial end points, whereas information on mortality and morbidity after cell transplantation is sparse. Several meta-analyses, each including various sets of studies, estimated that intracoronary cell therapy was associated with small reductions in left ventricular end-systolic volumes and a moderate increase in left ventricular ejection fraction of 2.9-6.1% over time compared with control patients. As most of the clinical trials included a limited number of patients, results vary substantially between different studies. When evaluating whether effects of intracoronary cell transplantation on parameters of left ventricular remodeling may be transferable to meaningful consequences in terms of clinical outcome, the following aspects appear to be imperative. Robust data on mortality and clinical events based on a sufficient number of patients are required. Furthermore, effects of cell therapy must be compared with established therapeutic concepts for the treatment of myocardial infarction, such as reperfusion therapy or pharmacological interventions aiming at favorably influencing the remodeling process. Moreover, the potential effects of cell therapy must be evaluated as treatment options additive to established therapeutic strategies.
Reffelmann
Thorsten
T
Klinik und Poliklinik für Innere Medizin B, Universitätsklinikum der Ernst-Moritz-Arndt-Universität Greifswald, Friedrich-Löffler Str. 23 a, 17475 Greifswald, Germany. thorstenreffelmann@web.de
Kloner
Robert A
RA
D016026:Bone Marrow Transplantation; D002986:Clinical Trials as Topic; D003331:Coronary Vessels / Q000166:cytology; D006801:Humans; D015201:Meta-Analysis as Topic; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000601:surgery*; D036102:Peripheral Blood Stem Cell Transplantation; D015424:Reperfusion; D013318:Stroke Volume; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000187:drug effects