Intracoronary infusion of autologous bone marrow cells and left ventricular function after acute myocardial infarction: A meta-analysis

Institute for Molecular Cardiovascular Research and Interdisciplinary Center for Clinical Research BIOMAT, RWTH University Hospital Aachen, Aachen, Germany.
Journal of Cellular and Molecular Medicine (Impact Factor: 4.01). 07/2006; 10(3):727-33. DOI: 10.1111/j.1582-4934.2006.tb00432.x
Source: PubMed


Recent clinical studies have demonstrated that intracoronary infusion of autologous bone marrow cells (BMC) in conjunction with standard treatment may improve left ventricular function after an acute myocardial infarction (AMI). However, the results of these studies remain controversial, as the studies were relatively small in size and partially differed in design. We reviewed primary controlled randomized clinical studies comparing intracoronary transfer of autologous non-mobilized BMC combined with standard therapy versus standard therapy alone in patients with AMI. We identified five randomized controlled clinical trials, three of which were also placebo- and bone marrow aspiration-controlled. Non-mobilized BMC were infused into the revascularized coronary target artery 6.6 +/- 6.1 days after AMI. The mean follow- up period of 5.2 +/- 1.1 months was completed by 482 patients, 241 of which received infusion of BMC. The effect of BMC on left ventricular ejection fraction (LVEF) as a major functional parameter was evaluated. Analyzing the overall effect on the change in LVEF between baseline and follow-up value revealed a significant improvement in the BMCtreated group as compared to the control group (P = 0.04). Thus, considering the increase in LVEF during follow-up, transplantation of BMC may be a safe and beneficial procedure to support treatment of AMI. However, the functional improvement observed with this form of therapy was altogether relatively moderate and the studies were heterogeneous in design. Hence, further efforts aiming at large-scale, double-blind, randomized and placebo-controlled multi-center trials in conjunction with better definition of patients, which benefit from BMC infusion, appear to be warranted.

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    • "In theory, the injected exogenous MSCs may have a capacity to restore or stimulate the resident/endogenous stem cells' capacity to regenerate damaged heart tissue [5] [6] [7]. However, despite the initial enormous expectation, recent clinical trials have shown only moderate improvement of left ventricular function but no obvious evidence of therapeutic effectiveness [8] [9] [10] [11] [12]. Our preclinical animal research also demonstrated that direct injection of autologous MSCs promotes angiogenesis and improves left ventricular ejection faction following chronic myocardial ischemia, but no myocardiogenesis was observed [13] [14]. "
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    • "A brief description of several of these trials is shown in Table 2. As a whole, a recent systematic review (Abdel-Latif et al 2007) and a meta-analysis (Hristov et al 2006) conclude that these interventions are feasible, safe, and associated to a small increase in left ventricular ejection fraction (LVEF). In addition, a recent meta-regression using data from ten studies show a dose-response effect for the infused volume when the ejection fraction is measured (Lipinski et al 2007). "
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