Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Cardiovasc Ther. 2010 Dec;28(6):380-5. doi: 10.1111/j.1755-5922.2009.00116.x.
Bone marrow stem cells are able to repair infarcted human myocardium following intracoronary transplantation via the infarct-relative artery. However, traditional reperfusion strategies fail to open the artery in some patients, making effective delivery impossible. Our previous study demonstrated a safe and efficient approach to delivering bone marrow stem cells via a noninfarcted artery in an animal myocardial infarction model. The objective of the present study was to evaluate the safety and feasibility of autologous bone marrow mesenchymal stem cell transplantation via such an approach in patients with acute myocardial infarction (AMI). Sixteen patients with anterior AMI who had successfully undergone percutaneous coronary intervention (PCI) were enrolled in this pilot, randomized study. Three weeks after PCI, cultured bone marrow mesenchymal stem cells were injected into the myocardium via either the infarct-relative artery (left anterior descending branch artery, LAD) or a noninfarct-relative artery (right coronary artery, RCA). The safety and feasibility of the cell infusion were evaluated during the procedure and during 6 months of follow-up. In addition, 2D echocardiography, technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) and 18F-deoxyglucose single photon emission computed tomography were employed to examine cardiac function, myocardial perfusion, and viable cardiomyocytes, respectively, at day 4 after PCI and 6 months after the cell infusion. There were no arrhythmia and any other side-effects, including infections, allergic reactions or adverse clinical events, during, immediately after, or 6 months after cell transplantation. Cardiac function and myocardial perfusion had improved 6 months after PCI/bone marrow stem cells transplantation. Viable cardiomyocytes metabolism was detected in the infarcted areas in both groups after the cell infusion, as demonstrated by 18F-deoxyglucose. Intracoronary infusion of autologous bone marrow mesenchymal stem cells via a noninfarct-relative artery appears safe and feasible in the treatment of patients with AMI.
骨髓干细胞能够通过冠状动脉内移植经梗死相关动脉修复梗死的人类心肌。然而，传统的再灌注策略在一些患者中无法使动脉再通，从而使有效的输送变得不可能。我们之前的研究证明了一种在动物心肌梗死模型中通过非梗死相关动脉有效输送骨髓干细胞的安全有效的方法。本研究的目的是评估通过这种方法在急性心肌梗死（AMI）患者中进行自体骨髓间充质干细胞移植的安全性和可行性。本研究纳入了 16 例前壁 AMI 患者，这些患者均成功接受了经皮冠状动脉介入治疗（PCI）。在 PCI 后 3 周，通过梗死相关动脉（前降支动脉，LAD）或非梗死相关动脉（右冠状动脉，RCA）将培养的骨髓间充质干细胞注入心肌。在该过程中和随访的 6 个月内评估细胞输注的安全性和可行性。此外，在 PCI 后 4 天和细胞输注后 6 个月，使用二维超声心动图、锝-99m 甲氧基异丁基异腈（99mTc-MIBI）和 18F-脱氧葡萄糖单光子发射计算机断层扫描分别检查心功能、心肌灌注和存活的心肌细胞。在细胞移植期间、移植后即刻和 6 个月后，均未发生心律失常和任何其他副作用，包括感染、过敏反应或不良临床事件。在 PCI/骨髓干细胞移植后 6 个月，心功能和心肌灌注均得到改善。在细胞输注后，两组的梗死区均检测到存活的心肌细胞代谢，这通过 18F-脱氧葡萄糖证实。通过非梗死相关动脉冠状动脉内输注自体骨髓间充质干细胞在治疗 AMI 患者中似乎是安全和可行的。
