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Stem-Cell Transplantation in Myocardial Infarction: A Status Report

Michael S. Lee, MD; and Raj R. Makkar, MD
[+] Article and Author Information

From St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons, New York, New York, and Cedars-Sinai Medical Center, University of California, Los Angeles School of Medicine, Los Angeles, California.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Raj R. Makkar, MD, Division of Cardiology, Cardiac Catheterization Laboratory, Cedars-Sinai Medical Center, 8631 West 3rd Street #415E, Los Angeles, CA 90048; e-mail, raj.makkar@cshs.org.

Current Author Addresses: Dr. Lee: Division of Cardiology, St. Luke's-Roosevelt Hospital, 1111 Amsterdam Avenue, New York, NY 10025.

Dr. Makkar: Division of Cardiology, Cardiac Catheterization Laboratory, Cedars-Sinai Medical Center, 8631 West 3rd Street #415E, Los Angeles, CA 90048.


Ann Intern Med. 2004;140(9):729-737. doi:10.7326/0003-4819-140-9-200405040-00013
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Myocardial infarction is the leading cause of congestive heart failure and death in the industrialized world. Current therapy is limited in preventing the progression of ventricular remodeling and congestive heart failure. Recent interest has focused on stem cells, which are undifferentiated and pluripotent cells that can proliferate, potentially self-renew, and differentiate into cardiomyocytes. Myocardial regeneration with stem-cell transplantation is a possible treatment option to reverse the deleterious hemodynamic and neurohormonal effects that occur after myocardial infarction and can lead to congestive heart failure. Various preclinical animal studies show the potential to regenerate myocardium and improve perfusion to the infarct area to improve cardiac function but also suggest that stem cells may have proarrhythmic effects. Early phase I clinical studies indicate that stem-cell transplantation is feasible and may have beneficial effects on ventricular remodeling after myocardial infarction. Future randomized clinical trials will establish the magnitude of the benefit and the effects on arrhythmias after stem-cell therapy.

Figures

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Figure 1.
Improved myocardial perfusion of infarcted anterior wall detected by 201-thallium scintigraphy 3 months after intracoronary transplantation of autologous, mononuclear bone marrow cells subsequent to an acute anterior myocardial infarction.

The images on the left (A ,D, sagittal) and in the middle (B,E ) show the long axis, whereas the images on the right (C, F, frontal) show the short axis of the heart. Initially, the anterior wall, with green apical and anterior regions, had reduced myocardial perfusion (A,B,C). Three months after cell transplantation, the same anterior wall (yellow) revealed a significant improvement in myocardial perfusion (D,E,F). All images were obtained during the exercise phase. Reproduced with permission from Strauer BE, Brehm M, Zeus T, Kostering M, Hernandez A, Sorg RV, et al. Repair of infarcted myocardium by autologous intracoronary mononuclear bone marrow cell transplantation in humans. Circulation. 2002;106:1913-8 (63).

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Figure 2.
Representative sequence of 2 septal endomyocardial injections.

A. Overlay to identify the 4 cardiac chambers and pulmonary artery, as well as the intracardiac-guiding catheter-receiver coil. B. Intracardiac-guiding catheter-receiver coil directed toward the interventricular septum without making direct contact.C. The spring-loaded 27-gauge injection needle (Stiletto; Boston Scientific, Maple Grove, Minnesota) is extended from the guiding catheter and engages the apical septum of the left ventricle. D.The same view with saturation preparation for background suppression. The first injection of gadolinium appears bright (arrow).E. The second injection is made 1 minute later, more proximally along the septum, with the same imaging plane as before. Gadolinium from the first, more distal, injection site remains visible.F. After saturation pulses are stopped, both injections remain visible in the myocardium. Injections typically remained visible for more than 10 minutes. Reproduced with permission from Lederman RJ, Guttman MA, Peters DC, Thompson RB, Sorger JM, Dick AJ, et al. Catheter-based endomyocardial injection with real-time magnetic resonance imaging. Circulation. 2002;105:1282-4 (75).

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Summary for Patients

Can Stem Cells Restore Cardiac Tissue after a Heart Attack?

The summary below is from the full report titled “Stem-Cell Transplantation in Myocardial Infarction: A Status Report.” It is in the 4 May 2004 issue of Annals of Internal Medicine (volume 140, pages 729-737). The authors are M.S. Lee and R.R. Makkar.

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