Adult Bone Marrow-Derived Cells for Cardiac Repair: A systematic review and meta-analysis

Harvard University, Cambridge, Massachusetts, United States
Archives of Internal Medicine (Impact Factor: 17.33). 05/2007; 167(10):989-97. DOI: 10.1001/archinte.167.10.989
Source: PubMed


The results from small clinical studies suggest that therapy with adult bone marrow (BM)-derived cells (BMCs) reduces infarct size and improves left ventricular function and perfusion. However, the effects of BMC transplantation in patients with ischemic heart disease remains unclear.
We searched MEDLINE, EMBASE, Science Citation Index, CINAHL (Cumulative Index to Nursing and Allied Health), and the Cochrane Central Register of Controlled Trials (CENTRAL) (through July 2006) for randomized controlled trials and cohort studies of BMC transplantation to treat ischemic heart disease. We conducted a random-effects meta-analysis across eligible studies measuring the same outcomes.
Eighteen studies (N = 999 patients) were eligible. The adult BMCs included BM mononuclear cells, BM mesenchymal stem cells, and BM-derived circulating progenitor cells. Compared with controls, BMC transplantation improved left ventricular ejection fraction (pooled difference, 3.66%; 95% confidence interval [CI], 1.93% to 5.40%; P<.001); reduced infarct scar size (-5.49%; 95% CI, -9.10% to -1.88%; P = .003); and reduced left ventricular end-systolic volume (-4.80 mL; 95% CI, -8.20 to -1.41 mL; P = .006).
The available evidence suggests that BMC transplantation is associated with modest improvements in physiologic and anatomic parameters in patients with both acute myocardial infarction and chronic ischemic heart disease, above and beyond conventional therapy. Therapy with BMCs seems safe. These results support conducting large randomized trials to evaluate the impact of BMC therapy vs the standard of care on patient-important outcomes.

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Available from: Ewa K Zuba-Surma
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    • "Characterization of CPCs is driving forward a new era in CV biology and stem and progenitor cell therapies that regenerate myocardium lost in the wake of ischemic or other injurious stimuli would have enormous benefit to humanity. Clinical data acquired thus far from cell therapy trials using bone marrow (BM) and cardiac-derived cell fractions (Abdel-Latif et al., 2007; Bolli et al., 2011; Clifford et al., 2012; Makkar et al., 2012) appear to be safe, although the therapeutic effect is modest at best (Nowbar et al., 2014) and in most cases the observed benefits likely involve paracrine effects on endogenous repair mechanisms rather than exogenous stem cell deployment (Laflamme and Murry, 2011). Thus, there is much to learn about the biology and therapeutic potential of these cells. "
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    • "Clinical trials using BMMNCs for cardiac repair have now been the subject of several meta-analyses (Abdel-Latif et al. 2007; Martin-Rendon et al. 2008; Clifford et al. 2012). Together, close to 2000 subjects have received BMMNCs as cell therapy for cardiac dysfunction (predominantly for ischemic cardiomyopathy). "
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