With evidence mounting that cell-based therapies can repair the injured myocardium following acute infarction, a Brazil-based research team addressed questions of the best way to safely deliver bone-marrow mononuclear cells (BMMNC) derived from the same patient (autologous cells) to the heart, following a heart attack caused by a prolonged interruption of blood flow leading to changes in the electrocardiogram (ST elevation myocardial infarction). They compared two different delivery techniques – through the anterograde intra-coronary (ICA) or via the retrograde intra-coronary artery vein (ICV). Researchers used radiolabeled cells to evaluate cell distribution patterns in the heart and their relationship with left ventricle function improvement.
"BMMNC retention by damaged heart tissue was apparently higher when the anterograde approach was used, although further studies are required to confirm this data," said corresponding author Dr. Hans Dohman of the Hospital Pro-Cardiaco in Rio de Janeiro, Brazil.
While previous reports observed that microvascular obstruction impairing cell uptake by the heart could be an issue, the team hypothesized that an intravenous approach may overcome that potential.
"We hypothesized that an intravenous approach might overcome this issue since the passage (diapedesis) of circulating cells into the adjacent cardiac tissue occurs on the venous side of microcirculation," added Dr. Dohman. "In addition, we found that the grade of obstruction of microcirculation does not correlate with the efficiency of cell delivery to the infarcted tissue."
The research team also found that higher cell retention correlated with better changes in observed ejection fraction from baseline to a six-month follow-up.
"Our data point toward a causal relationship between the total number of cells that participate in infarct repair and the final enhancement of cardiac function," concluded Dr. Dohman.
Contact: Hans Dohman, Hospital Pro-Cardiaco, Rua Dona Mariana 219, Botafogo, Rio de Janeiro, Brasil. CEP: 22280-000 Tel. (55) 21-21311584 Directoria.cientifica@procardiaco.com.br
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