Myocardial regeneration after intracoronary transplantation of human autologous stem cells following acute myocardial infarction

Myocardial infarction is characterised by myocardial necrosis with loss of contractile tissue as well as by a decrease in ventricular function. The infarct area is centrally necrosed, nonviable and scarred. Usually minimal residual perfusion is preserved. Depending on the initial size of the infarction, structural remodelling takes place, i. e. ventricular dilatation occurs and ventricular function decreases [2] [3] [5]. Early treatment with thrombolysis and/or mechanical procedures as balloon dilatation (PTCA) with or without stent implantation can reduce the infarction area. However, reduction of any existing necrosis is not possible [5].

Cardiomyocytes are irreparably damaged after myocardial infarction and there is no regeneration by precursor cells. Any myocardial neogenesis and, in a limited way, neovascularisation could improve left ventricular function and prevent remodelling [4] [6]. Experiments in a mouse model of infarct treatment by cell replacement have shown that intramyocardial injection of bone marrow stem cells into vital marginal zones can lead to regeneration [11]. Similar results were obtained with myocardial placement of cultured peripheral skeletal muscle cells [10], and with left-ventricular injection of mesenchymal progenitor cells [9]. Based on these findings we asked three clinical questions:

Is treatment of myocardial infarction with stem cells possible under clinical conditions? Are human autologous bone marrow stem cells, after separation of the haematopoetic cells, suitable as myocardial cell replacement? Can intramyocardial transplantation be achieved by transcatheter intracoronary infusion into the infarcted area via the coronary arteries that supply the marginal zone?

This report demonstrates that intracoronary transplantation of autologous stem cells is possible and clinically feasible using the described method.

References

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