Stem Cell Therapy Improves Heart Function After MI
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Patients with impaired ventricular function following a myocardial infarction may be able to pump new life into damaged heart muscle with an infusion of their own bone marrow-derived progenitor cells.
In a placebo-controlled trial, patients who received an infusion of the recycled cells improved their global left ventricular function by 5.5%, versus a 3% improvement in patients who received placebo infusions (P=0.014), according to Andreas M. Zeiher, M.D., of J.W. Goethe University in Frankfurt, Germany.
Moreover, patients who received the stem cell infusions five or more days after myocardial infarction had a 7% improvement in left-ventricular ejection function compared with a 1.9% improvement in placebo patients who were infused with acellular serum at least five days after heart attack (P=0.004), Dr. Zeiber reported at the American Heart Association’s meeting here today.
Dr. Zeiher said the stem cell infusion is the first therapy “that has the potential to not only limit damage, but also regenerate heart function.”
As might be expected, patients with the most significant ischemic damage following MI benefited the most from the progenitor cell therapy, said co-author Volker Scha"chinger, M.D., of the Frankfurt group.
The investigators randomized 95 patients to the bone marrow cell treatment and 92 to placebo. All patients underwent bone marrow aspiration at three to five days after an MI and infusions were done on days three to six.
At four months clinical follow-up “all major hazard ratios—myocardial infarction, revascularization, and rehospitalization—favored the bone-marrow group,” he said.
Timothy Gardner, M.D., who is chair of the AHA’s program committee and is medical director at the Center for Heart and Vascular Health of the Christiana Care Health System in Wilmington, Del., cautioned that the results should be interpreted carefully.
“It is unclear—at least to me—if the benefit is caused by an immune reaction to the treatment, which would stimulate growth factors or it is a direct result of the treatment,” Dr. Gardner said. But that aside he pointed out that the study was well-designed, “placebo controlled and multicenter.”
Dr. Scha"chinger countered by pointing out that even though patients in both groups were infused—a procedure that could trigger an immune response - “there was an added benefit in the patients who received the bone marrow cell infusions over the placebo.”
The study, Reinfusion of Enriched Progenitor Cells And Infarct Remodeling in Acute Myocardial Infarction (REPAIR-AMI), enrolled patients after they had completed successful acute reperfusion therapy for acute ST elevation MI.
At baseline the average ejection fraction was 47% in the placebo group and 48% in the bone marrow arm.
At four months, 41 patients in the bone marrow arm had LVEF below 49% compared with 52 patients in the placebo arm (P=0.002), Dr. Scha"chinger said.
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