Intramyocardial bone marrow cell transplantation and the progression of coronary atherosclerosis in patients with chronic myocardial ischemia

Abstract

Cell therapy has been proposed as a novel treatment strategy for patients with ischemic heart disease. However, two recent studies suggested that cardiac cell transplantation might aggravate coronary atherosclerosis. The aim of the current study was to assess whether intramyocardial bone marrow cell transplantation in patients with chronic myocardial ischemia is associated with progression of coronary atherosclerosis. In 30 patients with chronic ischemia, bone marrow was aspirated from the iliac crest. During mononuclear cell isolation, coronary angiography was performed. Thereafter, 94+/-18 x 10(6) cells were injected intramyocardially (NOGA system) in regions with ischemia on technetium-99m tetrofosmin SPECT. During the 12-month follow-up period, there was no clinical evidence of progression of atherosclerosis. CCS class improved from 3.4+/-0.5 to 2.4+/-0.8 at 3 months, 2.4+/-0.9 at 6 months and 2.5+/-0.9 at 12 months (P<0.01). MRI-determined left ventricular ejection fraction increased from 51+/-12% to 54+/-12% at 3 months (P<0.01) and the number of ischemic segments per patient on SPECT decreased from 5.2+/-2.6 to 2.1+/-2.2 at 3 months (P<0.01). Repeat coronary angiography at 4 months revealed that bone marrow cell transplantation did not decrease minimal luminal diameter (1.81+/-0.80 mm versus 1.79+/-0.82 mm, P = NS) or mean luminal diameter (2.48+/-0.85 mm versus 2.46+/-0.86 mm, P = NS). Similarly, the percentage diameter stenosis (32+/-19% versus 32+/-20%, P = NS) and the atheromatosis severity score (4.78+/-2.40 versus 4.80+/-2.40, P = NS) remained unchanged. Intramyocardial bone marrow cell transplantation in patients with chronic myocardial ischemia was not associated with significant progression of atherosclerosis.