ABSTRACT
BACKGROUND: Currently, most of the clinical trials of cell transplantation for ischemic heart disease is the transplantation of bone marrow mononuclear cells through the bypass graft artery in patients with acute myocardial infarction, but reports in combination with cell transplantation for old myocardial infarction are few. OBJECTIVE: To investigate the safety and feasibility of intracoronary artery injection of bone marrow mononuclear cells through the bypass graft artery during coronary artery bypass grafting (CABG). DESIGN: Self-control and case analysis. PARTICIPANTS: A total of 10 patients who had old myocardial infarction, left ventricular ejection fraction (LVEF)≤40%, were selected from Cardiovascular Institute and Fuwai Hospital from November 2004 to June 2005. METHODS: The bone marrow mononuclear cells were harvested from the bone marrow by Ficoll density gradient centrifugation method before the CABG was carried. And the patients received CABG and 10 mL mononuclear cell suspension through the grafts into anterior descending branch. In addition, 10 mL mononuclear cell suspension was injected into the circumflex branch and right coronary artery through the proximal heart. MAIN OUTCOME MEASURES: The heart function was evaluated with transthoracic echocardiography (TEE) and cardiac MRI after the operation. RESULTS: All patients recovered. A total of 45-60 mL bone marrow was harvested from iliac crest, and 4.1 ×10~7 mononuclear cells were isolated and identified by trypan blue test (cell activity >95%). TEE showed that the LVEF at 1 week and 1, 3 months postoperatively was significantly improved compared with before operation; creatase arid troponin T were not increased, and no myocardial infarction changes were found. MRI showed that the LVEF was significantly increased following operation (P < 0.01); left ventricular end-diastolic and systolic diameters were significantly decreased (P < 0.05). There was no complication associating with bone marrow harvest, or cell transplantation. CONCLUSION: Bone marrow mononuclear cells transplantation through bypass graft, as an adjunctive therapy, is safe and feasible.
ABSTRACT
Objective To investigate the retainage rate,distribution,and emigration of the bone marrow mesenchymal stem cell(BMMSC) after transcoronary infusion and to further evaluate the feasibility of injecting BMMSCs into coronary artery.Methods BMMSCs were isolated,purified,expanded,and labelled with CM-DiI.The infarcted SD rat hearts were removed and perfused with Langendorff apparatus.The cells were injected into the aortic root and the fluid returning from the coronary system was collected and the labelled cells in the coronary effluent were quantitated with flowcytometry.At the same time,left ventricle function was recorded to evaluate the safety of this approach.In vivo study,the cells were then injected into clamped ascending aorta through a catheter inserted through the left ventricle into the aortic root.The hearts were harvested at different time points after cell transplantation to obtain the direct evidence of distribution and emigration of the implanted cells.Results Only 3%～5% of transplanted cells returned into the right ventricle and more than 90% cells retained in the heart after beinginjected into aortic root of Langendorff model of infarcted hearts of SD rats.Left ventricle function did not deteriorate after cell transplantation.The labelled cells were entrapped within the coronary capillary immediately after cell infusion,mainly in the normal area.After 24 hours some cells migrated through the capillary wall into interstitium of the heart.One week later we found that most survival cells located at the infarcted area and the border zone.Conclusion The majority of BMMSCs delivered by transcoronary infusion retained in the heart.BMMSCs can penetrate the vessel wall and home back to the interstitial compartment and the injured area in a few hours.
ABSTRACT
Objective: To discuss the values of serum S100 protein in evaluating the cerebral injuries during and after cardiopulmonary bypass (CPB). Methods: 40 patients (25 valve replacement, 13 simple congenital heart disease, 2 valve replacement plus CABG) were studied. Serum S100 protein was serially assessed at different time intervals and the patients' neuropyscological complications were recorded. Results: S100 was not detected before CPB, and it reached its peak level at the termination of CPB, then gradually decrease to the preoperative levels. Three patients with the highest level appeared neuropyscological mobidity. Conclusion: S100 protein has significant change during CPB, and may reflect both the severity of the cerebral injury and increased permeability of the blood brain barrier. Its level has very great significance in evaluating cerebral injuries.