Intramyocardial injection of autologous bone marrow cells as an adjunctive therapy to incomplete myocardial revascularization: safety issues
Gowdak, Luís Henrique W; Schettert, Isolmar T; Baptista, Eduardo; Lopes, Nailú L. G; Rochitte, Carlos Eduardo; Vieira, Marcelo Luiz C; Grupi, César José; César, Luiz Antonio M; Krieger, José Eduardo; Oliveira, Sérgio A. de.
Clinics
; 63(2): 207-214, 2008. graf, tab
Artículo
en Inglés
| LILACS | ID: lil-481050
OBJECTIVES:
To determine the safety of intramyocardial injection of autologous bone marrow cells in patients undergoing surgical myocardial revascularization (CABG) for severe coronary artery disease.INTRODUCTION:
There is little data available regarding the safety profile of autologous bone marrow cells injected during surgical myocardial revascularization. Potential risks include arrythmias, fibrosis in the injected sites and growth of non-cardiac tissues.METHODS:
Ten patients (eight men) were enrolled; they were 59±5 years old with limiting angina and were non-optimal candidates for complete CABG. Bone marrow cells (1.3±0.3x10(8)) were obtained prior to surgery, and the lymphomonocytic fraction (CD34+=1.8±0.3 percent) was separated by density gradient centrifugation. During surgery, bone marrow cells were injected in non-grafted areas of ischemic myocardium. During the first year after surgery, the patients underwent laboratory tests, cardiac imaging, and 24-hour ECG monitoring.RESULTS:
Injected segments inferior (n=7), anterior (n=2), septal (n=1), apical (n=1), and lateral (n=1) walls. Except for a transient elevation of C-reactive protein at one month post-surgery (P=0.01), laboratory tests results were within normal ranges; neither complex arrhythmias nor structural abnormalities were detected during follow-up. There was a reduction in functional class of angina from 3.6±0.8 (baseline) to 1.2±0.4 (one year) (P<0.0001). Also, patients had a significant decrease in the ischemic score assessed by magnetic resonance, not only globally from 0.65±0.14 (baseline) to 0.17±0.05 (one year) (P=0.002), but also in the injected areas from 1.11±0.20 (baseline) to 0.34±0.13 (one year) (P=0.0009).CONCLUSIONS:
Intramyocardial injection of bone marrow cells combined with CABG appears to be safe. Theoretical concerns with arrhythmias and/or structural abnormalities after cell therapy...Asunto(s)
Adolescente Adulto Anciano Anciano de 80 o más Años Femenino Humanos Masculino Persona de Mediana Edad Adulto Joven Trasplante de Médula Ósea/métodos Isquemia Miocárdica/cirugía Revascularización Miocárdica/métodos Angina de Pecho/cirugía Biomarcadores Células de la Médula Ósea/citología Trasplante de Médula Ósea/mortalidad Ecocardiografía Métodos Epidemiológicos Citometría de Flujo Imagen por Resonancia Magnética Neovascularización Fisiológica Trasplante Autólogo Resultado del Tratamiento Adulto Joven
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