[Interventional, intramyocardial stem cell therapy in ischemic cardiomyopathy: update 2010].
BACKGROUND
The intracoronary application of autologous bone marrow cells has proven hitherto to be safe but not sufficiently effective in patients with ischemic cardiomyopathy. The interventional application of cells injected directly into the myocardium represents one possible approach to improve effectiveness.


METHODS
The NOGA method is based on the CARTO technique, which has been evaluated extensively for safety and feasibility in patients with heart failure. In a first step, an electrically and anatomically exact map of the left ventricle is obtained. Guided by this three-dimensional map direct injection of the cells into the ischemic area can be easily performed.


METHODS
Since its introduction in 2002 many studies have proven the safety, feasibility and effectiveness of NOGA-guided regenerative therapy to the left ventricle. While several studies also suggest effectiveness regarding various parameters of left ventricular function, no larger multicenter study is available to date. Such studies with also clinical endpoints are currently ongoing.


CONCLUSIONS
The currently available data support, but do not yet prove, the hypothesis that intramyocardial stem cell therapy using NOGA-guided injection into the myocardium is safe and feasible in both acute and chronic ischemic cardiomyopathy. Ongoing trials will reveal whether this approach will become the standard form for applying cell therapy to the heart.
Bergmann
M W
MW
Klinik für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstrasse 5, Hamburg, Germany. docbergmann@mac.com
Jaquet
K
K
Schneider
C
C
Krause
K
K
Ujeyl
A
A
Kuck
K-H
KH
D016026:Bone Marrow Transplantation / Q000379:methods*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D048091:Guided Tissue Regeneration; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007273:Injections, Intramuscular; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000628:therapy*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left / Q000502:physiology
Circ Heart Fail. 2010 Jan;3(1):89-96
19996415
Nature. 2001 Apr 5;410(6829):701-5
11287958
Circulation. 2006 Mar 14;113(10):1287-94
16520413
Proc Natl Acad Sci U S A. 2006 Jun 13;103(24):9226-31
16754876
Circulation. 2004 Sep 14;110(11 Suppl 1):II213-8
15364865
J Card Fail. 2008 Dec;14(10):861-72
19041051
Proc Natl Acad Sci U S A. 2008 Dec 16;105(50):19762-7
19073933
Transfusion. 2009 Apr;49(4):786-96
19170985
Cardiology. 2009;113(3):155-60
19122455
Lancet. 2004 Jul 10-16;364(9429):141-8
15246726
N Engl J Med. 2006 Sep 21;355(12):1210-21
16990384
Eur Heart J. 2008 Oct;29(19):2388-442
18799522
J Am Coll Cardiol. 2010 Mar 30;55(13):1385-94
20338501
J Thorac Cardiovasc Surg. 2007 Mar;133(3):717-25
17320570
Nat Biotechnol. 2005 Jul;23(7):845-56
16003373
J Clin Invest. 2001 Jun;107(11):1395-402
11390421
Eur Heart J. 2009 Jun;30(11):1313-21
19208649
Circulation. 2003 May 13;107(18):2294-302
12707230
Heart. 2009 Jul;95(14):1145-52
19336430
Science. 2009 Apr 3;324(5923):98-102
19342590
J Clin Invest. 2005 Mar;115(3):572-83
15765139
Science. 2009 Oct 16;326(5951):426-9
19833966