Emory University, Atlanta, GA, USA.
Am Heart J. 2011 Jan;161(1):98-105. doi: 10.1016/j.ahj.2010.09.025.
the objective of the study was to determine whether the effects of infarct-related artery (IRA) infusion of autologous bone marrow-derived CD34(+) cells after ST elevation myocardial infarction (STEMI) are dependent on the dose (quantity and mobility) of the cells infused. Beneficial effects of IRA infusion of mononuclear cells after STEMI have been inconsistent, possibly because of differences in timing, cell type, quantity, and mobility of infused cells.
patients were randomized to bone marrow harvest (n = 16) or control (n = 15). At a median of 8.3 days after coronary stenting for STEMI, CD34(+) cells were infused via the IRA at 3 dose levels (5, 10, and 15 × 10(6)) in cohorts of 5 patients each. Baseline and follow-up imaging and ex vivo CD34(+) cell mobility were performed.
Cell harvest and infusion were safe. Quantitative rest hypoperfusion score measured by single-photon emission computed tomography improved at 6 months in the ≥ 10 million cohorts compared with controls (-256 vs +14, P = .02). There was a trend toward improved ejection fraction at 6 months (+4.5%) in the ≥ 10 million cohorts compared with no change in the controls and 5 million cohort (+0.7%). Improved perfusion and infarct size reduction correlated with the quantity and mobility of the infused CD34(+) cells.
the effects of CD34(+) cell IRA infusion during the repair phase after STEMI are dose dependent and, at a threshold dose of 10 million CD34(+) cells, associated with a significant improvement in perfusion that may limit deterioration in cardiac function (IRA infusion of CD34(+) cells in patients with acute myocardial infarction [AMR-01] NCT00313339).
本研究旨在确定 ST 段抬高型心肌梗死（STEMI）后梗死相关动脉（IRA）输注自体骨髓源性 CD34+细胞的效果是否依赖于输注细胞的剂量（数量和迁移性）。单核细胞IRA 输注对 STEMI 的有益作用并不一致，可能是由于输注细胞的时间、细胞类型、数量和迁移性的差异。
患者被随机分为骨髓采集组（n = 16）或对照组（n = 15）。在 STEMI 经皮冠状动脉支架置入术后中位数 8.3 天，通过 IRA 以 5、10 和 15×106 每个剂量级各 5 例的方式输注 CD34+细胞。进行基线和随访成像以及体外 CD34+细胞迁移性检测。
细胞采集和输注是安全的。单光子发射计算机断层扫描（SPECT）测量的定量静息低灌注评分在 6 个月时在≥1000 万组与对照组相比（-256 对+14，P =.02）得到改善。与对照组和 500 万组无变化相比，≥1000 万组的射血分数在 6 个月时有改善趋势（+4.5%）。改善的灌注和梗死面积缩小与输注的 CD34+细胞的数量和迁移性相关。
在 STEMI 后修复阶段 IRA 输注 CD34+细胞的效果是剂量依赖性的，在 1000 万 CD34+细胞的阈值剂量下，与灌注的显著改善相关，这可能限制了心脏功能的恶化（急性心肌梗死患者的 IRA 输注 CD34+细胞[AMR-01]NCT00313339）。
