Effect of autologous bone marrow mononuclear cells transplantation in diabetic patients with ST-segment elevation myocardial infarction

• Published in: International journal of cardiology 2013-07, Vol.167 (2), p.537-547
• Main Authors: Sun, Dongdong, Narsinh, Kazim, Wang, Haichang, Li, Chengxiang, Li, Weijie, Zhang, Zheng, Li, Jiayi, Cao, Feng
• Format: Article
• Language: English
• Subjects: Adult; Angina; Biological and medical sciences; Bone marrow mononuclear cells; Bone Marrow Transplantation - methods; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Diabetes; Diabetes Mellitus - diagnostic imaging; Diabetes Mellitus - epidemiology; Diabetes Mellitus - surgery; Diabetes. Impaired glucose tolerance; Diseases of the cardiovascular system; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; Heart; Humans; Left ventricular function; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - epidemiology; Myocardial Infarction - surgery; Myocarditis. Cardiomyopathies; Percutaneous coronary intervention; Radionuclide Imaging; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); ST-segment elevation myocardial infarction; Transplantation, Autologous; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2012.01.068

Abstract Background To investigate the efficacy and proposed mechanism of bone marrow mononuclear cells (BMMNCs) transplantation for diabetic and non-diabetic patients with ST-segment elevation myocardial infarction (STEMI). Methods One hundred and sixteen patients with STEMI who had successfully undergone percutaneous coronary intervention (PCI) were divided into a diabetic group (n = 51) and non-diabetic group (n = 65). All of the patients received intracoronary injection of BMMNCs. Results Diabetes down-regulated IGF-1, IGFBP-5, VEGF, SDF-1, IL-6, IL-1α and TNF-α expression and affected the expression of Bmi-1, Gfi1, Tel and Hox-B4 which could prevent premature senescence and maintain the self-renewal capacity of stem cells. Event-free survival rates were not statistically different between the diabetic and non-diabetic group (80% vs. 72.5%, p = 0.382). LV ejection fraction (LVEF) and wall motion score index (WMSI) were evaluated by echocardiography and found to be significantly improved in the non-diabetic group compared to the diabetic group over the 4-year follow-up period. Improved myocardial perfusion and reduced infarct size in the non-diabetic group compared to the diabetic group was verified using single-photon emission computed tomographic (SPECT) imaging. The non-diabetic group also had reduced anginal symptoms as assessed by changes in their Seattle Angina Questionnaire scores and Canadian Cardiovascular Society (CCS) Functional Angina classification. An improvement of 6-minute walk distance (6MWD) was also noted to be higher in the non-diabetic group during the follow-up period. Conclusion This study indicates that the beneficial effect of BMMNCs transplantation for STEMI is less pronounced in diabetic patients. The mechanism is associated with decreased BMMNCs function in diabetic patients.