Catheter-based Autologous bone marrow myocardial injection in no-option patients with advanced coronary artery disease: A feasibility study

• Published in: Journal of the American College of Cardiology 2003-05, Vol.41 (10), p.1721-1724
• Main Authors: FUCHS, Shmuel, SALTER, Lowell F, EPSTEIN, Stephen E, KORNOWSKI, Ran, OKUBAGZI, Petros, WEISZ, Giora, BAFFOUR, Richard, WAKSMAN, Ron, WEISSMAN, Neil J, CERQUEIRA, Manuel, LEON, Martin B
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angiogenesis; Applied cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone Marrow Transplantation; Cardiology; Cardiovascular disease; Catheterization; Coronary Circulation; Coronary Disease - diagnostic imaging; Coronary Disease - therapy; Coronary vessels; Feasibility Studies; Female; Heart - diagnostic imaging; Heart attacks; Humans; Injections; Ischemia; Kinases; Male; Medical sciences; Middle Aged; Myocardium; Patients; Pilot Projects; Placebo effect; Tomography, Emission-Computed, Single-Photon; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Autologous; Vascular endothelial growth factor
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(03)00328-0

We conducted a pilot study to evaluate the feasibility of transendocardial delivery of autologous bone marrow (ABM) strategy in patients with severe symptomatic chronic myocardial ischemia not amenable to conventional revascularization. Transendocardial injection of ABM cells appears to enhance perfusion of ischemic porcine myocardium. Ten patients underwent transendocardial injection of freshly aspirated and filtered unfractionated ABM using left ventricular electromechanical guidance. Twelve injections of 0.2 ml each were successfully delivered into ischemic noninfarcted myocardium pre-identified by single-photon emission computed tomography perfusion imaging. Autologous bone marrow injection was successful in all patients and was associated with no serious adverse effects; in particular, there was no arrhythmia, evidence of infection, myocardial inflammation, or increased scar formation. Two patients were readmitted for recurrent chest pain. At three months, Canadian Cardiovascular Society angina score significantly improved (3.1 +/- 0.3 vs. 2.0 +/- 0.94, p = 0.001), as well as stress-induced ischemia occurring within the injected territories (2.1 +/- 0.8 vs. 1.6 +/- 0.8, p < 0.001). Treadmill exercise duration, available in nine patients, increased, but the change was not significant (391 +/- 155 vs. 485 +/- 198, p = 0.11). This study provides preliminary clinical data indicating feasibility of catheter-based transendocardial delivery of ABM to ischemic myocardium.