Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Int J Cardiol. 2011 Jun 16;149(3):310-4. doi: 10.1016/j.ijcard.2010.02.008. Epub 2010 Mar 2.
Animal and human clinical studies have indicated that bone marrow (BM) mononuclear cell (MNC) therapy for Chagasic Cardiomyopathy (ChC) is feasible, safe and potentially efficacious. Nevertheless, little is known about the retention of these cells after intracoronary (IC) infusion.
Our study investigated the homing of technetium-99m ((99m)Tc) labeled BM MNCs and compared it to thallium-201 ((201)Tl) myocardial perfusion images using the standard 17-segment model. Six patients with congestive heart failure of chagasic etiology were included.
Scintigraphic images revealed an uptake of 5.4%±1.7, 4.3%±1.5 and 2.3%±0.6 of the total infused radioactivity in the heart after 1, 3 and 24h, respectively. The remaining activity was distributed mainly to the liver and spleen. Of 102 segments analyzed, homing took place in 36%. Segments with perfusion had greater homing (58.6%) than those with decreased or no perfusion (6.8%), p<0.0001. There was no correlation between the number of injected cells and the number of segments with homing for each patient (r=-0.172, p=0.774).
These results indicate that (99m)Tc-BM MNCs delivered by IC injection homed to the chagasic myocardium. However, cell biodistribution was heterogeneous and limited, being strongly associated with the myocardial perfusion pattern at rest. These initial data suggest that the IC route may present limitations in chagasic patients and that alternative routes of cell administration may be necessary.
动物和人体临床研究表明，骨髓（BM）单核细胞（MNC）治疗恰加斯心肌病（ChC）是可行的、安全的且可能有效的。然而，对于这些细胞经冠状动脉内（IC）输注后的保留情况知之甚少。
我们的研究使用标准的 17 节段模型，研究了锝-99m（99mTc）标记的 BM MNC 的归巢，并将其与铊-201（201Tl）心肌灌注图像进行了比较。纳入了 6 例充血性心力衰竭的恰加斯病因患者。
放射性示踪图像显示，在 1、3 和 24 小时后，心脏中总输注放射性摄取分别为 5.4%±1.7、4.3%±1.5 和 2.3%±0.6。剩余的活性主要分布在肝脏和脾脏。在分析的 102 个节段中，有 36%发生了归巢。有灌注的节段比灌注减少或无灌注的节段有更高的归巢率（58.6%比 6.8%，p<0.0001）。每位患者的注射细胞数量与有归巢的节段数量之间没有相关性（r=-0.172，p=0.774）。
这些结果表明，通过 IC 注射递送的 99mTc-BM MNC 归巢到恰加斯心肌病的心肌。然而，细胞的生物分布是不均匀和有限的，与静息时的心肌灌注模式密切相关。这些初步数据表明，IC 途径可能在恰加斯病患者中存在局限性，可能需要替代的细胞给药途径。
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