Early Cardiac Retention of Administered Stem Cells Determines Clinical Efficacy of Cell Therapy in Patients With Dilated Cardiomyopathy

Abstract

The diagnosis of nonischemic dilated cardiomypathy (DCM) comprises a primary myocardial disease of various causes, which is characterized by left ventricular (LV) dilation and impaired myocardial contractility. Although a broad range of pharmacological and device therapies are available, morbidity and mortality remain high in patients with advanced DCM. Thus, there is an urgent need for novel therapies aiming at functional regeneration of myocardial contractility in DCM. Although regenerative therapies using administration of a variety of different cell types have emerged as a promising approach to improve heart function in patients with ischemic disease,1 only a few pilot studies have investigated intracoronary application of autologous bone marrow–derived cells (BMC) in patients with DCM. Seth et al2 performed intracoronary infusion of BMC in 24 patients with DCM and reported a modest 5% increase in LV ejection fraction in parallel with an increased ratio of capillaries to myocytes as evidenced by endomyocardial biopsies at 6 months. In the TOPCARE-DCM pilot study including 33 patients, the improvement in global and regional LV contractile function was rather heterogeneous but was also paralleled by improved microvascular function as assessed by measuring coronary flow reserve at 3 months after intracoronary infusion of BMC.3 Article, see p 165 In this issue of Circulation Research , Vrtovec et al4 now considerably extend these previous observations. The authors randomized 110 patients with DCM to either intracoronary …