Cardiac bone marrow cell therapy: the proof of the pudding remains in the eating

Abstract

This editorial refers to ‘Intracoronary infusion of mononuclear cells from bone marrow or peripheral blood compared with standard therapy in patients after acute myocardial infarction treated by primary percutaneous coronary intervention: results of the randomized controlled HEBE trial’[†][1], by A. Hirsch et al. , on page 1736 , and ‘Intracoronary autologous mononucleated bone marrow cell infusion for acute myocardial infarction: results of the randomized multicenter BONAMI trial’[‡][2], by J. Roncalli et al. , on page 1748 During the last two decades, the substantial decline in short-term mortality in patients with acute myocardial infarction (AMI) has markedly increased the prevalence of patients who are admitted to cardiology wards with left ventricular (LV) dysfunction. Despite state-of-the-art pharmacological and device-based treatment, the injured myocardium often appears unable to reverse massive cumulative cardiac cell death and loss of contractile function. The net result is progressive ventricular dilatation and development of heart failure, which remains a major cause of morbidity and mortality.1 The inadequate endogenous regenerative capacity of the heart following extensive ischaemic injury has stimulated research efforts using stem or progenitor cells as a unique and exciting opportunity for true cardiac repair and perhaps regeneration. The field of clinical cardiac cell therapy has witnessed a remarkable and rapid progress, since the very first reports of adult stem cell transfer in small animal models almost a decade ago. The observations that intramyocardial injection of adult bone marrow cells (BMCs) can improve LV contractile function through regeneration2 or neovascularization3 have triggered great enthusiasm about a possible treatment enabling cell-based biological repair. The first generation of randomized controlled trials in patients with AMI explored the safety and efficacy of intracoronary injection of autologous mononuclear BMCs at variable time intervals following reperfusion. They almost uniformly focused on global left ventricular ejection fraction (LVEF) as a surrogate marker … [1]: #fn-2 [2]: #fn-3