title: Bone marrow cell transplantation in Chagas' disease heart failure: report of the first human experience.
abstract: BACKGROUND
  Heart failure due to Chagas' disease (HFCD) is a progressive inflammatory cardiomyopathy that affects millions of individuals in Latin America. Studies using mice models of HFCD indicate that bone marrow mononuclear cell transplantation (BMCT) may reduce inflammation, fibrosis, and improve myocardial function.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate, for the first time in humans, the safety and efficacy of BMCT to the myocardium of patients with HFCD.
  
  
  METHODS
  A total of 28 HFCD patients (mean age 52.2 ± 9.9 years) with NYHA class III and IV were submitted to BMCT through intracoronary injection. Effects on the left ventricle ejection fraction (LVEF), functional capacity, quality-of-life, arrhythmias, biochemical, immunological, and neuro-humoral parameters, were evaluated.
  
  
  RESULTS
  There were no complications directly related to the procedure. LVEF was 20.1 ± 6.8% and 28.3 ± 7.9%, p < 0.03 at baseline and 180 days after the procedure, respectively. In the same period, significant improvements were observed in the NYHA class (3.1 ± 0.3 to 1.8 ± 0.5; p < 0.001), quality-of-life (50.9 ± 11.7 to 25.1 ± 15.9; p < 0.001), and in the six-minute walking test (355 ± 136 m to 437 ± 94 m; p < 0,01). There were no changes in markers of immune or neurohormonal activation. No complications were registered.
  
  
  CONCLUSIONS
  Our data suggest that the intracoronary injection of BMCT is safe and potentially effective in patients with HFCD. The extent of the benefit, however, appears to be small and needs to be confirmed in a larger randomized, double blind, placebo controlled clinical trial.
authors.affiliation: Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Brazil. fabiovboas@cardiol.br
authors.forename: Fábio
authors.initials: F
authors.lastname: Vilas-Boas
authors.forename: Gilson Soares
authors.initials: GS
authors.lastname: Feitosa
authors.forename: Milena B P
authors.initials: MB
authors.lastname: Soares
authors.forename: Jole Alves
authors.initials: JA
authors.lastname: Pinho-Filho
authors.forename: Augusto C A
authors.initials: AC
authors.lastname: Mota
authors.forename: Augusto José Gonçalves
authors.initials: AJ
authors.lastname: Almeida
authors.forename: Marcus Vinícius
authors.initials: MV
authors.lastname: Andrade
authors.forename: Heitor Ghissoni
authors.initials: HG
authors.lastname: Carvalho
authors.forename: Adriano Dourado
authors.initials: AD
authors.lastname: Oliveira
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ribeiro-dos-Santos
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000276:immunology; D002598:Chagas Cardiomyopathy / Q000150:complications / Q000601:surgery*; D005260:Female; D015200:Fluoroimmunoassay; D018093:Gelatinases / Q000032:analysis; D006333:Heart Failure / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015846:Monokines / Q000032:analysis; D010865:Pilot Projects; D011788:Quality of Life; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015846:Monokines; D018093:Gelatinases