Functional improvement in patients with dilated cardiomyopathy after the intracoronary infusion of autologous bone marrow mononuclear cells.
OBJECTIVE
Different studies have shown improvement in patients with idiopathic nonischemic dilated cardiomyopathy treated with cell-therapy. However, factors influencing responsiveness are not well known. This trial investigates functional changes and factors influencing the 6-month gain in ejection fraction in 27 patients with dilated cardiomiopathy treated with intracoronary cell-therapy.


METHODS
Patients received intracoronary infusion of autologous bone-marrow mononuclear cells (mean infused, 10.2 [2.9]×10(8)). Flow cytometry and functional analyses of the cells were also performed.


RESULTS
The 6-month angiographic gain in ejection fraction ranged from -9% to 34% (mean, 9%). These changes were distinguished into 2 groups: 21 patients (78%) with a significant improvement at the 6-month evaluation (mean gain, 14 [7]%), and 6 patients who had no response (mean gain, -5 [3]%). The responders were younger as compared to the nonresponders (50 [12] years vs 62 [9] years; P<.04). There was an inverse correlation (r=-0.41; P<.003) between the gain in ejection fraction and the high density lipoprotein level, suggesting higher functional gain with low high density lipoprotein levels. The 24 h migratory capability of the infused cells was significantly reduced in the responders' group (5.4 [1.7]×10(8) vs 8.1 [2.3]×10(8); P<.009 for vascular endothelial growth factor and 5.8 [1.7]×10(8) vs 8.4 [2.9]×10(8); P<.002 for stromal cell-derived factor-1).


CONCLUSIONS
Younger patients with dilated cardiomiopathy and lower plasma high density lipoprotein levels gain greater benefit from intracoronary cell-therapy. Functional improvement also seems to be enhanced by a lower migratory capacity of the infused cells.
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain. Electronic address: grupo_corpal@arrakis.es.
José
J
Suárez de Lezo
Unidad de Terapia Celular, Hospital Universitario Reina Sofía, Córdoba, Spain.
Concepción
C
Herrera
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
Miguel
M
Romero
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
Manuel
M
Pan
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
Javier
J
Suárez de Lezo
Unidad de Terapia Celular, Hospital Universitario Reina Sofía, Córdoba, Spain.
María Dolores
MD
Carmona
Unidad de Terapia Celular, Hospital Universitario Reina Sofía, Córdoba, Spain.
Rosario
R
Jiménez
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
José
J
Segura
Unidad de Terapia Celular, Hospital Universitario Reina Sofía, Córdoba, Spain.
Sonia
S
Nogueras
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
Dolores
D
Mesa
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
Djordje
D
Pavlovic
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
Soledad
S
Ojeda
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
Francisco
F
Mazuelos
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
Mónica
M
Delgado
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
Martin
M
Ruiz
Unidad de Terapia Celular, Hospital Universitario Reina Sofía, Córdoba, Spain.
María Luisa
ML
Castilla
Unidad de Terapia Celular, Hospital Universitario Reina Sofía, Córdoba, Spain.
Antonio
A
Torres
D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography