Abstract
Clinical trials of intracoronary injection of bone marrow-derived stem cells (BMCs) in patients with acute myocardial infarction (AMI) have revealed promising but variable and modest results. One of the reasons underlying this situation may be the unstandardized preparation of BMCs. The aim of this study was to explore whether methodological differences affect the prognosis of acute myocardial infarction patients who received BMCs transplantation. MEDLINE was searched for randomized controlled trials providing AMI patients with intracoronary BMCs injection or a standard therapy. Changes in cardiac parameters and clinical outcomes were analyzed. Subgroup analyses were conducted according to different methodologies for cell preparation, including supplement for serum or plasma, use of heparin and cell washout. Non-use of serum or plasma in the cell suspension is associated with more reduction in infarct size (IS) and a lower risk of all-cause mortality. Heparin usage could diminish the benefit in reducing IS. All-cause mortality rose significantly without the cell washout procedure when heparin was used. Methodological differences in BMCs preparation as well as the use of heparin and serum/ plasma impact on the prognosis of AMI patients.
Highlights
Clinical trials of intracoronary injection of bone marrow-derived stem cells (BMCs) in patients with acute myocardial infarction (AMI) have revealed promising results
Non-use of serum or plasma in the cell suspension is associated with more reduction in infarct size (IS) and a lower risk of all-cause mortality
We focused on the therapeutic effect of BMCs in patients with AMI through an intracoronary infusion of BMCs
Summary
Clinical trials of intracoronary injection of bone marrow-derived stem cells (BMCs) in patients with acute myocardial infarction (AMI) have revealed promising results. One reason underlying the variable and modest improvement of cardiac function by cell therapy may be related to the unstandardized preparation of BMCs. Serum or plasma, which in some trials was used to provide a suitable physiological environment for BMCs, was reported to induce clotting of the cell product. Heparin, used to prevent coagulation during cell preparation in many clinical trials, has recently been shown to affect the survival and functionality of BMCs. the objective of this systematic review and meta-analysis is to explore whether the usage of serum or plasma, heparin and steps of washout during cell preparation may have influenced the results of previous trials. Clinical trials of intracoronary injection of bone marrow-derived stem cells (BMCs) in patients with acute myocardial infarction (AMI) have revealed promising but variable and modest results. One of the reasons underlying this situation may be the unstandardized preparation of BMCs
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