Strauer B E, Brehm M, Zeus T, Gattermann N, Hernandez A, Sorg R V, Kögler G, Wernet P
Klinik für Kardiologie, Pneumologie und Angiologie, Germany.
Dtsch Med Wochenschr. 2001 Aug 24;126(34-35):932-8. doi: 10.1055/s-2001-16579-2.
The regenerative potential of human autologous adult stem cells on myocardial regeneration and neovascularisation after myocardial infarction may contribute to healing of the infarction area. But no clinical application has previously been reported. We here describe for the first time the results of this method applied in a patient who had sustained an acute myocardial infarction.
14 hours after the onset of left precordial pain a 46-year-old man was admitted to our hospital for interventional diagnosis and treatment. Coronary angiography demonstrated occlusion of the anterior descending branch of the left coronary artery with transmural infarction. This was treated by percutaneous transluminal catheter angioplasty and stent placement.
Mononuclear bone marrow cells of the patient were prepared and 6 days after infaction 1,2 infinity 107 cells were transplanted at low pressure via a percutaneous transluminal catheter placed in the infarct-related artery. Before and 10 weeks after this procedure left ventricular function, infarct size, ventricular geometry and myocardial perfusion were measured by (201)thallium SPECT both at rest and on exercise, together with bull's-eye analysis, dobutamine stress echocardiography, right heart catheterisation and radionuclide ventriculography. At 10 weeks after the stem cell transplantation the transmural infarct area had been reduced from 24.6 % to 15.7 % of left ventricular circumference, while ejection fraction, cardiac index and stroke volume had increased by 20-30 %. On exercise the end diastolic volume had decreased by 30 % and there was a comparable fall in left ventricular filling pressure (mean pulmonary capillary pressure).
These results for the first time demonstrate that selective intracoronary transplantation of human autologous adult stem cells is possible under clinical conditions and that it can lead to regeneration of the myocardial scar after transmural infarction. The therapeutic effects may be ascribed to stem cell-associated myocardial regeneration and neovascularisation.
人类自体成体干细胞在心肌梗死后心肌再生和新生血管形成方面的再生潜力可能有助于梗死区域的愈合。但此前尚无临床应用的报道。我们在此首次描述了该方法应用于一名急性心肌梗死患者的结果。
一名46岁男性在左胸前区疼痛发作14小时后因介入诊断和治疗入院。冠状动脉造影显示左冠状动脉前降支闭塞并透壁梗死。采用经皮腔内冠状动脉成形术和支架置入术进行治疗。
制备患者的单核骨髓细胞，在梗死6天后，通过置于梗死相关动脉的经皮腔内导管以低压方式移植1.2×10⁷个细胞。在该操作前及操作后10周，通过静息和运动状态下的（201）铊单光子发射计算机断层扫描（SPECT），以及靶心分析、多巴酚丁胺负荷超声心动图、右心导管检查和放射性核素心室造影测量左心室功能、梗死面积、心室几何形态和心肌灌注。干细胞移植后10周，透壁梗死面积从左心室周长的24.6%降至15.7%，而射血分数、心脏指数和每搏量增加了20% - 30%。运动时舒张末期容积减少了30%，左心室充盈压（平均肺毛细血管压）也有类似下降。
这些结果首次证明在临床条件下人类自体成体干细胞选择性冠状动脉内移植是可行的，并且可导致透壁梗死后心肌瘢痕的再生。治疗效果可能归因于干细胞相关的心肌再生和新生血管形成。
