title: Randomized transcoronary delivery of CD34(+) cells with perfusion versus stop-flow method in patients with recent myocardial infarction: Early cardiac retention of ⁹⁹(m)Tc-labeled cells activity.
abstract: BACKGROUND
  For transcoronary progenitor cells' administration, injections under flow arrest (over-the-wire balloon technique, OTW) are used universally despite lack of evidence for being required for cell delivery or being effective in stimulating myocardial engraftment. Flow-mediated endothelial rolling is mandatory for subsequent cell adhesion and extravasation.
  
  
  METHODS
  To optimize cell directing toward the coronary endothelium under maintained flow, the authors developed a cell-delivery side-holed perfusion catheter (PC). Thirty-four patients (36-69 years, 30 men) with primary stent-assisted angioplasty-treated anterior MI (peak TnI 151 [53-356]ng/dL, mean[range]) were randomly assigned to OTW or PC autologous ⁹⁹Tc-extametazime-labeled bone marrow CD34(+) cells (4.34 [0.92-7.54] × 10⁶) administration at 6-14 days after pPCI (LVEF 37.1 [24-44]%). Myocardial perfusion (⁹⁹(m)Tc-MIBI) and labeled cells' activity were evaluated (SPECT) at, respectively, 36-48 h prior to and 60 min after delivery.
  
  
  RESULTS
  In contrast to OTW coronary occlusions, no intolerance or ventricular arrhythmia occurred with PC cells' administration (P < .001). One hour after delivery, 4.86 [1.7-7.6]% and 5.05 [2.2-9.9]% activity was detected in the myocardium (OTW and PC, respectively, P = .84). Labeled cell activity was clearly limited to the (viable) peri-infarct zone in 88% patients, indicating that the infarct core zone may be largely inaccessible to transcoronary-administered cells.
  
  
  CONCLUSIONS
  Irrespective of the transcoronary delivery method, only ≈ 5% of native (i.e., non-engineered) CD34(+) cells spontaneously home to the injured myocardium, and cell retention occurs preferentially in the viable peri-infarct zone. Although the efficacy of cell delivery is not increased with the perfusion method, by avoiding provoking ischemic episodes PC offers a rational alternative to the OTW delivery.
authors.affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Institute of Cardiology, Jagiellonian University, Krakow, Poland. pmusialek@szpitaljp2.krakow.pl
authors.forename: Piotr
authors.initials: P
authors.lastname: Musialek
authors.forename: Lukasz
authors.initials: L
authors.lastname: Tekieli
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kostkiewicz
authors.forename: Marcin
authors.initials: M
authors.lastname: Majka
authors.forename: Wojciech
authors.initials: W
authors.lastname: Szot
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Walter
authors.forename: Anna
authors.initials: A
authors.lastname: Zebzda
authors.forename: Piotr
authors.initials: P
authors.lastname: Pieniazek
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kadzielski
authors.forename: R Pawel
authors.initials: RP
authors.lastname: Banys
authors.forename: Maria
authors.initials: M
authors.lastname: Olszowska
authors.forename: Mieczyslaw
authors.initials: M
authors.lastname: Pasowicz
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Zmudka
authors.forename: Wieslawa
authors.initials: W
authors.lastname: Tracz
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D058948:Cell Tracking / Q000379:methods*; D005260:Female; D051157:Frizzled Receptors / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000276:immunology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000601:surgery*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D019275:Radiopharmaceuticals; D043562:Receptors, G-Protein-Coupled / Q000276:immunology; D013194:Staining and Labeling / Q000379:methods; D013667:Technetium / Q000493:pharmacokinetics; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome
chemical_list: C549560:FZD9 protein, human; D051157:Frizzled Receptors; D019275:Radiopharmaceuticals; D043562:Receptors, G-Protein-Coupled; D013667:Technetium