Kanamori Taro, Watanabe Go, Yasuda Tamotsu, Nagamine Hiroshi, Kamiya Hiroyuki, Koshida Yoshinao
Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
Ann Thorac Surg. 2006 Jan;81(1):160-7. doi: 10.1016/j.athoracsur.2005.07.021.
The conditions at the injection site are important in cell transplantation for severe ischemic heart disease. The omentum is both a well-vascularized tissue and a source of angiogenic factors. We examined the effectiveness of autologous bone marrow-derived mononuclear cells (BM-MNCs) with or without omentopexy in a large animal model.
Myocardial infarction was generated in the lateral wall by ligation of coronary artery branches in miniswine. Animals received BM-MNC injection with or without omentopexy. Controls received saline only. Three weeks after surgery, regional myocardial blood flow and contractility were measured, and density of arterioles was evaluated immunohistologically. Angiography and postmortem examinations were performed to determine collateral communication.
Regional myocardial contractility was significantly improved by BM-MNC transplantation both with and without omentopexy (0.29 +/- 0.02 vs 0.11 +/- 0.03, p < 0.01, 0.30 +/- 0.02 vs 0.12 +/- 0.01, p < 0.01, respectively). Relative regional myocardial blood flow in the combined omentopexy group was significantly higher than the controls both at rest (1.05 +/- 0.11 vs 0.57 +/- 0.07, p < 0.01) and under stress (1.09 +/- 0.08 vs 0.40 +/- 0.10, p < 0.01). The number of arterioles (< 50 microm) in both groups were higher than the controls (88.1 +/- 5.00 vs 38.1 +/- 8.99, p < 0.01 and 109.2 +/- 9.91 vs 38.1 +/- 8.99, p < 0.01, respectively). The number of large arterioles (> 50 microm) in the combined omentopexy group was significantly higher than in both BM-MNC alone (26.9 +/- 2.4 vs 17.6 +/- 1.8, p = 0.011) and controls (26.9 +/- 2.4 vs 10.0 +/- 1.3, p < 0.01). Collateral communication between the omentum and myocardium was demonstrated by angiography and postmortem injection.
The BM-MNC transplantation may attenuate cardiac contractile dysfunction, and omentopexy may enhance angiogenesis induced by BM-MNC transplantation.
在严重缺血性心脏病的细胞移植中，注射部位的条件很重要。大网膜既是血管丰富的组织，也是血管生成因子的来源。我们在大型动物模型中研究了自体骨髓来源的单个核细胞（BM-MNCs）联合或不联合大网膜固定术的效果。
通过结扎小型猪冠状动脉分支在其侧壁造成心肌梗死。动物接受BM-MNC注射，联合或不联合大网膜固定术。对照组仅接受生理盐水注射。术后3周，测量局部心肌血流和收缩力，并通过免疫组织化学评估小动脉密度。进行血管造影和尸检以确定侧支循环情况。
联合或不联合大网膜固定术的BM-MNC移植均显著改善了局部心肌收缩力（分别为0.29±0.02对0.11±0.03，p<0.01；0.30±0.02对0.12±0.01，p<0.01）。联合大网膜固定术组静息时（1.05±0.11对0.57±0.07，p<0.01）和应激时（1.09±0.08对0.40±0.10，p<0.01）的相对局部心肌血流均显著高于对照组。两组小动脉（<50微米）数量均高于对照组（分别为88.1±5.00对38.1±8.99，p<0.01；109.2±9.91对38.1±8.99，p<0.01）。联合大网膜固定术组大血管（>50微米）数量显著高于单独BM-MNC组（26.9±2.4对17.6±1.8，p=0.011）和对照组（26.9±2.4对10.0±1.3，p<0.01）。血管造影和尸检注射证实了大网膜与心肌之间的侧支循环。
BM-MNC移植可能减轻心脏收缩功能障碍，大网膜固定术可能增强BM-MNC移植诱导的血管生成。
