Current stem cell protocols for ischemic heart disease are limited by the smal l numbers of cells that can be obtained by bone marrow aspirate. To increase myo cardial delivery of bone marrow stem cells in patients wi...Current stem cell protocols for ischemic heart disease are limited by the smal l numbers of cells that can be obtained by bone marrow aspirate. To increase myo cardial delivery of bone marrow stem cells in patients with chronic ischemic hea rt disease(CIHD), we used granulocyte colony stimulating factor(G-CSF) for bone marrow mobilization of CD34+cells, enabling intracoronary infusion of large nu mbers of CD34+stem cells. Patients with CIHD(n=5) demonstrated significantly re duced numbers of CD34+cells mobilized by G-CSF in comparison to age-matched c ontrols. Sustained reduction in anginal symptoms and improvement in quality of l ife scores was seen in all patients following infusion of cells. Moreover, mean collateral flow grade at 12-month follow-up angiography significantly improved , indicating sustained myocardial neovascularization. No proliferative retinopat hy was induced and no in-stent restenosis seen. However, in two patients with d ocumented increase in collateral flow, complications arose, one developing an ac ute coronary syndrome and the other a lentigo maligna. These results demonstrate the feasibility of G-CSF mobilization, leukapheresis and intracoronary transfe r of CD34+stem cells in patients with CIHD, but longer-term studies are requir ed to ensure that this protocol is safe and effective.展开更多
文摘Current stem cell protocols for ischemic heart disease are limited by the smal l numbers of cells that can be obtained by bone marrow aspirate. To increase myo cardial delivery of bone marrow stem cells in patients with chronic ischemic hea rt disease(CIHD), we used granulocyte colony stimulating factor(G-CSF) for bone marrow mobilization of CD34+cells, enabling intracoronary infusion of large nu mbers of CD34+stem cells. Patients with CIHD(n=5) demonstrated significantly re duced numbers of CD34+cells mobilized by G-CSF in comparison to age-matched c ontrols. Sustained reduction in anginal symptoms and improvement in quality of l ife scores was seen in all patients following infusion of cells. Moreover, mean collateral flow grade at 12-month follow-up angiography significantly improved , indicating sustained myocardial neovascularization. No proliferative retinopat hy was induced and no in-stent restenosis seen. However, in two patients with d ocumented increase in collateral flow, complications arose, one developing an ac ute coronary syndrome and the other a lentigo maligna. These results demonstrate the feasibility of G-CSF mobilization, leukapheresis and intracoronary transfe r of CD34+stem cells in patients with CIHD, but longer-term studies are requir ed to ensure that this protocol is safe and effective.
