Stem Cell Center, Texas Heart Institute, St Luke's Episcopal Hospital, Houston, TX, USA.
Am Heart J. 2011 Jun;161(6):1078-87.e3. doi: 10.1016/j.ahj.2011.01.028. Epub 2011 May 10.
Autologous bone marrow mononuclear cell (ABMMNC) therapy has shown promise in patients with heart failure (HF). Cell function analysis may be important in interpreting trial results.
In this prospective study, we evaluated the safety and efficacy of the transendocardial delivery of ABMMNCs in no-option patients with chronic HF. Efficacy was assessed by maximal myocardial oxygen consumption, single photon emission computed tomography, 2-dimensional echocardiography, and quality-of-life assessment (Minnesota Living with Heart Failure and Short Form 36). We also characterized patients' bone marrow cells by flow cytometry, colony-forming unit, and proliferative assays.
Cell-treated (n = 20) and control patients (n = 10) were similar at baseline. The procedure was safe; adverse events were similar in both groups. Canadian Cardiovascular Society angina score improved significantly (P = .001) in cell-treated patients, but function was not affected. Quality-of-life scores improved significantly at 6 months (P = .009 Minnesota Living with Heart Failure and P = .002 physical component of Short Form 36) over baseline in cell-treated but not control patients. Single photon emission computed tomography data suggested a trend toward improved perfusion in cell-treated patients. The proportion of fixed defects significantly increased in control (P = .02) but not in treated patients (P = .16). Function of patients' bone marrow mononuclear cells was severely impaired. Stratifying cell results by age showed that younger patients (≤60 years) had significantly more mesenchymal progenitor cells (colony-forming unit fibroblasts) than patients >60 years (20.16 ± 14.6 vs 10.92 ± 7.8, P = .04). Furthermore, cell-treated younger patients had significantly improved maximal myocardial oxygen consumption (15 ± 5.8, 18.6 ± 2.7, and 17 ± 3.7 mL/kg per minute at baseline, 3 months, and 6 months, respectively) compared with similarly aged control patients (14.3 ± 2.5, 13.7 ± 3.7, and 14.6 ± 4.7 mL/kg per minute, P = .04).
ABMMNC therapy is safe and improves symptoms, quality of life, and possibly perfusion in patients with chronic HF.
自体骨髓单个核细胞（ABMMNC）治疗在心力衰竭（HF）患者中显示出前景。细胞功能分析对于解释试验结果可能很重要。
在这项前瞻性研究中，我们评估了经心内膜递送 ABMMNC 在无选择慢性 HF 患者中的安全性和疗效。通过最大心肌耗氧量、单光子发射计算机断层扫描、二维超声心动图和生活质量评估（明尼苏达州心力衰竭生活质量量表和 36 项简短健康调查问卷）评估疗效。我们还通过流式细胞术、集落形成单位和增殖测定来描述患者的骨髓细胞。
细胞治疗组（n = 20）和对照组（n = 10）在基线时相似。该过程是安全的；两组的不良事件相似。加拿大心血管学会心绞痛评分在细胞治疗组显著改善（P =.001），但功能未受影响。与对照组相比，细胞治疗组的生活质量评分在 6 个月时（Minnesota 心力衰竭生活质量量表 P =.009，36 项简短健康调查问卷的生理成分 P =.002）较基线显著改善。单光子发射计算机断层扫描数据提示细胞治疗组灌注有改善趋势。对照组固定缺陷比例显著增加（P =.02），而治疗组无显著变化（P =.16）。患者骨髓单个核细胞的功能严重受损。按年龄分层细胞结果显示，≤60 岁的年轻患者（n = 10）比>60 岁的患者（n = 10）具有更多的间充质祖细胞（集落形成单位成纤维细胞）（20.16 ± 14.6 比 10.92 ± 7.8，P =.04）。此外，与年龄相仿的对照组相比，细胞治疗的年轻患者的最大心肌耗氧量显著改善（分别为 15 ± 5.8、18.6 ± 2.7 和 17 ± 3.7 mL/kg/min，基线、3 个月和 6 个月）（P =.04）。
ABMMNC 治疗是安全的，并可改善慢性 HF 患者的症状、生活质量和可能的灌注。
