Effect of intramyocardial bone marrow-derived mononuclear cell injection on cardiac sympathetic innervation in patients with chronic myocardial ischemia.
Intramyocardial bone marrow cell injection has been associated with improvements in myocardial perfusion and left ventricular function. The current substudy of a randomized, placebo-controlled, double-blinded study, investigated the effect of intramyocardial bone marrow cell injection on myocardial sympathetic innervation in patients with chronic myocardial ischemia. In a total of 16 patients (64 ± 8 years, 13 men), early and late iodine-123 metaiodobenzylguanidine (MIBG) imaging was performed before and 3 months after intramyocardial bone marrow cell injection. No improvements were observed in global early H/M ratio (P = 0.40), late H/M ratio (P = 0.43) and cardiac washout rate (P = 0.98). However, late 123-I MIBG SPECT defect score showed a trend to improvement in the bone marrow cell group (from 31.0 ± 7.1 to 28.1 ± 14.9) as compared to the placebo group (from 33.6 ± 8.5 to 34.5 ± 9.8, P = 0.055 between groups). This trend was mainly driven by a substantial improvement in three bone marrow cell-treated patients, which all had diabetes and severe MIBG defects. In these patients, the extent and severity of MIBG defects improved substantially independent of myocardial perfusion and cell injection sites. The present study does not demonstrate improvements in global cardiac sympathetic nerve innervation after intramyocardial bone marrow cell injection in patients with chronic myocardial ischemia. However, regional analysis of sympathetic nerve innervation reveals improvements in three diabetic patients independent of myocardial perfusion, suggestive of a therapeutic effect on diabetic cardiac sympathetic dysinnervation.
Department of Cardiology, Leiden University Medical Centre, Post Office Box 9600, 2300 RC, Leiden, The Netherlands.
Jan
J
van Ramshorst
Saskia L M A
SL
Beeres
Sander F
SF
Rodrigo
Petra
P
Dibbets-Schneider
Arthur J
AJ
Scholte
Willem E
WE
Fibbe
Jaap J
JJ
Zwaginga
Martin J
MJ
Schalij
Jeroen J
JJ
Bax
Douwe E
DE
Atsma
D019797:3-Iodobenzylguanidine; D000704:Analysis of Variance; D016026:Bone Marrow Transplantation / Q000379:methods*; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging* / Q000294:innervation*; D006801:Humans; D007457:Iodine Radioisotopes; D007963:Leukocytes, Mononuclear / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy*; D019275:Radiopharmaceuticals; D012720:Severity of Illness Index; D013564:Sympathetic Nervous System / Q000000981:diagnostic imaging* / Q000601:surgery; D013667:Technetium; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome
D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D013667:Technetium